DISASTER POLICY AND HEALTH ISSUES (GENERAL)
Item
- Title
- DISASTER POLICY AND HEALTH ISSUES (GENERAL)
- extracted text
-
RF_DM_2_SUDHA
STATE HEALTH POLICY - DISASTER RESPONSE AND MANAGEMENT
A disaster is a situation arising out of an event which
creates a DISRUPTION of a GREAT MAGNITUDE in life (Human/
Animal/plant) and life supporting systems (Water/Air/Food/
Sunlight, etc.)*
This separates a disaster from an accident
or incident.
Disaster events are of sudden onset and diffuse effects.
Simplistic classification as ’natural* and ’man-made* are
misleading, as a complex relationship between these two is
being increasingly appreciated.
A spectrum of events from the
’natural’ to ’man-made* as cause and acute to chronic in time
scale is more practical.
Eg.: Natural / Acute
--
Earthquakes.
Natural /Chronic --
Drought
Man-made/Acute
Armed conflict
Man-made/Chronic --- Caste communal tensions.
Events like Droughts, Deforestation / Epidemics and Endemic
diseases have elements of both.
Similarly, Disaster “effects” can be placed on a spectrum
of Acute to Chronic in time-scale and implications for nature
and man.
Eg.: On nature / acute
——— kills all life
On nature / chronic ---
pollution/dwindling genetic diversity
On man / acute
---- death / shock
On man / Chronic
---
stress diseases / morbidity.
Intermediate stages with elements of both are also seen.
2
-2-
Response to disasters is in three phases a) RESCUE and Immediate Relief --
this needs Emergency
medical measures;
b) SHORT-TERM rehabilitation
--- needs continuing medical
and Public Health measures
to tackle emerging diseases/
epidemics.
c) LONG-TERM rehabilitation
--
needs predominantly
Public Health measures with
community participation.
Also, preparation for the
next disaster.
Some characteristics of disaster situations which are
universal need to be understood to evolve adequate plans for
coping.
a) PRE. DURING AND POST-DISASTER CONTINUUM:
All conditions which existed before a disaster are
likely to continue afterwards - in a more ACUTE form.
This
applies to Medical / Social / Economic / Political, etc.
b) The worst affected in a community are the most needy -
- socio-economically backward;
- women, children and the aged;
- destitutes, daily-wage earners, etc.
c) The Family is the basic coping unit and people evolve
an adaptive response seeking safety and stability at personal,
family and social levels, depending on their level of preparedness
to a disaster.
d) A majority of people manifest acute stress reactions
with no long-term psychological impairment, and.
e) Medical relief stations tend to become focal points of
all human misery during a disaster.
The needs are predominantly
for information, food, shelter, safe water and solace.
3
3-
Considering all these, the planning by the Medical /
Health establishment should include:
a) activitating / understanding / operationalising the
District Disaster plan (at the collectorate and District
Collector) in mock drills at regular internals;
b) preparation of support systems like personnel/
drug-stores/transport/mapping of area (indicating communication
channels/disease patterns/area most likely to be affected, etc*)
and logistic needs like liaison with food /transport and other
authorities, including areas of responsibility and channels
of reporting or seeking help;
c) Training, Education and Preparation of personnel
volunteers from the community and Voluntary Agencies in the
area.
d) Rationalising all the above in terms of peoples
perceptions, needs and capabilities.
In short, ensuring peoples
participation in all the above,for optimal benefit; and
e) Learning from the past disasters, while making the
present situation most favourable to survival so that any
disaster leaves minimal effects on people.
-x-x-x-x-x-x-
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ms
12-18 May, 1991
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Inadequate relief goods
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Catastrophe as Pornography
I
and Public Relations
X:
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New equation in
JP leadership
’4
»
Govt and Opposition
contradict each other on
relief distribution
-
SUNDAY
Vol 2 No 3
llllOBRp
12-18 May, 1991
Chairman, Editorial Board
Motahar Hossain Siddiqui
Editor
Ahmedul Ameen
Associate Editor
Nilratan Halder
Executive Editor
Syed Badrul Ahsan
Asstt. Executive Editor
Toufique Imrose Khalidi
Staff Correspondent
Shehabuddin Kisslu
Sports and Entertainment
Masud Ali Khan
Chandra Shekhar Das
Nazmul Bari
Sabreen S. Rahman
I
•ra
The gin^rrurunt of Be^htfKfidifddf Zia oiight to have dorie
.................
bettdpm^ibddhdMWl
*
• •
Bangladesh
ini^ht have done the same. Or not done
ahytliinc at allo Iffcif
pduiffffhe
truth thcd has emerged'today is that the government has
failed tbfdff. what it was expected
Viy>ive&Bi^
its predicament. Those excuses are untenable, and they drily
cover tip the fact
■' have | nof. affected
truths, and . in . the process |
Computer Consultant
Mahbub ur Rahman
imelectedfTheidfttiiiddi^
Circulation Manager
Mohiuddin Ahmed
Cover
Goutam Chakraborty
Published by the Editor from
Press Bangla, Bhagabati Banargee
Road, Dhaka.
Office : 50/F Inner Circular Road,
(3rd floor), Shantinagar, Dhaka
Phone: 831187, 417932
•
taken crrrnpletely unawares by the magnitude of the cyclone
thatstrwfkk the country fs coaftdl Ae^ppSdfddfddsP.lohyf huo.
But they should not have, for the particular reason that
they knew . what ' was
Arts Advisor
Dev Das Chakrabarty
Reader-in-Charge
Abu Eusuf Mia
J
' its actions.
W* will remind file goverhrdetity and
Ntff^fwiiidf^odf
over, it is management of the consequences that should
assume priority. Begum Zia ought not to misunderstand. No
thematterof distribution of relief'or saving aircraft parked
Sunday Express 01
X
Sunday Express 02
Favoured Biman pilot
Sir,
\\ /FTy attent'on has been drawn to the article
V B under caption "Utter negligence of a
Biman Pilot" which appeared in the issue of 28th
April - 4th May of your esteemed weekly.
It is astonishing as to how Civil Aviation
Authority of Bangladesh can keep quiet ignoring
such an incidence of importance. It seems that the
captain is unduly favoured or a certain group is
being maintained by the CAAB and the negligence
is being suppressed intentionally.
The matter is of national importance involving
the security of life and property. Due investigation
should be made an punishment should be given for
the negligence. We believe the new minister and the
secretary will take action and weed out all corrupt
and inefficient personnel who were appointed in
CAAB without proper qualification by the past
regime.
•
Abul Khalleque
12, Rankin Street,
Wari, Dhaka.
Zia \ Bangladeshis
Sir
his refers to Maj. Zia’s ’The birth of a
nation’ published in 28 April-4 May issue
from the weekly ’Bichitra’ in 1974. It makes history
weep once again.
It is sad to speak about the so called
’Bangladeshis’ who either deliberately or ignorantly
concede to distortion of facts. I think progressive
people i.e., the Bangalees should look inward. And
why not, when a valiant freedom fighter appears to
be a patron of ’Razakers’ and once holding a sheer,
ideology of Bengali nationalism indulges in
anti-liberation politics? He maintains camaraderie
with communal forces rooting out secularism from
the constitution. Zia’s divergence from his
standpoint of pre-75 assembling the communal
forces and reactionaries on the same platform in the
name of 'Bangladeshi nationalism’ has added a new
T
■>
J
twist to the politics of Bangladesh. From that inanity
of our national identity persuaded by the Zia regime
in collaboration with the reactionists, we are yet to
emerge free. Calumny against our Father of the
Nation, controversy on the declaration of
independence, phobia of so called Indian
aggression, using religion to fulfil political
lust-the'se are well-planned practices of the post-75
legacy. And the nation is helplessly somersautting
in that position. It is not the Awami League but the
self-proclaimed nationalists who are basking after
the downfall of Ershad.Let the progressive forces
ovecome their crisis and uphold our national spirit
which has been exiled after the assassination of
Bangabandhu.
Thanks to Sunday
courage to the nation.
Express
for
providing
Sazzad Masud
316-ZiaHall
Dhaka University.
Wave of death: Bravo! Keep it
up
our cover story ’WAVE OF DEATH' reveals
a lot of things related to why and how
waves of death periodically cause havoc in this
ancient land. The "Genesis of cyclonic storm",
’SIGNALS’, "why does Bangladesh become the
target of cyclone often?" are all befitting. On top of
all, "Questions in people’s mind" is a superb
composition.
Moreover, your story reveals the sheer
negligence of the Bangladesh Air Force and Navy
personnel and you have boldly pointed fingers at
these facts. Formation of an enquiry committee by
the Acting President the very next day of the
publication of your magazine probably followed
your report. Bravo! Keep it up.
Y
Monica
Shantinagar, Dhaka.
Sunday Express 03
--------------- *--------------- 7"
'—""
"
_____________
'
1 ■
—
WAVE C>F DEATH
________
Govt and Opposition
contradict each other
on relief distribution
1
Airlifting of relief materials by
helicopters costs about Taka
10,000 per hour but what the
bereaved, battered, haggard and
hungry people get to eat, drink
and also cover themselves are
much too inadequate. In the
absence of interment of human
bodies and carcasses the entire
affected area has turned into a
According to prime
minister and government
leaders there is no lack of
coordination in relief
works and everybody is
getting support. Shelters
will soon be provided.
...
-..........................................
veritable hell leading to
outbreak of diarrhoea in
epidemic form.
an
an
The situation is grave. No
doubt about the enormity of the
calamity and its consequences.
But it has been made worse by the
lack of coordination between
different
agencies
and
the
government. No wonder, the
armed forces, who are the most
I
Sunday Express 04
efficient organ in bringing in
control the situation in the
aftermath of natural calamities, are
carrying
on
relief
operation
separately. Neither have they been
assigned to the task in a manner
the situation demands.
The situation has been further
complicated by the ruling BNP
deciding to face it on party basis
instead of nationally. People were
disappointed
at
the
prime
minister’s rejection of the proposal
to form a national committee at the
Jatiya Sangsad. Consequently, the
opposition parties have been
forced to separately conduct their
relief operations.
Students, particularly those of
Dhaka University, have always
been in the forefront of relief works
in all such emergency situations,
but this time they too are
somewhat
inactive.
The
government is responsible for not
pulling the students and people
together for the task.
Yet another disturbing factor is
that the local MPs--possibly
because they belong to the
Opposition-have
not
been
included in the relief committee.
• All this is then reflected in the
aid given by the donors. Foreign
donors are reluctant to hand over
•
.
*•
* * • ••••• •••••••« • • • • • • ■
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•••
.
•
a
••.•••••’
’ft * • * • ■
.’’*.**,***
a■* *a " * *
.
* * ••• •
After her visit of the
cyclone affected areas in
Chittagong and Cox’s
Bazar, leader of the
opposition Sheikh
Hasina said at a press
conference on May
that the government has
completely failed to
reach relief materials to
the affected areas. She
complained the
administration lacks
coordination. After six
days people did not get
relief goods. She said no
less than 10 lakh people
were dead.
7
relief goods to the government,
they are giving those to the NGOs.
Mercifully though, the NGOs are
doing commendable, jobs. Yet
what is ponderable is the fact that
till May 9 last, the assurance of
WAVE OF DEATH ’
only 27 percent of the required aid
could be received.
I
It will be intersting to note the
conflicting views and statements of
the ruling party versus opposition
parties:
On May 7 prime minister
Khaleda Zia told at a press
conference it was impossible to
satisfy anyone with aid in this poor
country. She termed the press
report on the spread of diarrhoea
in an epidemic form as an
exaggeration.
I
According to prime minister
* and government leaders there is
no lack of coordination in relief
works and everybody is getting
support. Shelters will soon be
provided.
After her visit of the cyclone
affected areas in Chittagong and
Cox’s Bazar, leader of the
opposition Sheikh Hasina said at a
press conference on May 7 that
the government has completely
failed to reach relief materials to
the
affected
areas.
She
complained the administration
lacks coordination. After six days
people did not get relief goods.
She said no less than 10 lakh
people were dead.
Dr Kamal Hossain called for all
to engage in relief works sinking
differences. He also demanded the
formation of national task force.
On the
other hand
14
opposition and independent MPs,
after having visited affected areas
of Chittagong and Cox’s Bazar,
said the government has totally
failed to face the situation.
The government could not inter
the bodies, let alone reaching relief
materials to the affected people.
The MPs who made this complaint
are among others, Abdur Razzak,
Suranjit Sen Gupta, Rashed
Khan Menon, Salahuddin Kader
Suranjit Sen Gupta
complained one the basis
of his tour experience that
the affected people have
lost confidence in the
government.
Chowdhury, Shahjahan Siraj,
Azizur
Rahman,
Mohiuddin
Ahmed and A.S.M. Firoj.
.Suranjit Sen Gupta complained
one the basis of his tour
experience that the affected
people have lost confidence in the
government.
Shahjahan Siraj charged the
government has kept people in
constant panic. It has failed to
deploy the army and BDR.
Azizur Rahman said people will
never forgive the government for
the death and sufferings caused by
its negligence. Uptil May 7, no
government high official visited
Banshkhali, the worst hit area.
Mohiuddin Ahmed remarked it
was alleged to have buried dead
bodies . covered with banana
leaves in 1975, but today there is
no arrangement for internment.
Former deputy prime minister
and acting chairman of JP,
Moudud Ahmed pointed out the
failures of the government in
reaching relief goods and also
demanded the publication of
upazila-wise distribution of relief
goods.
Criticising the failure of the
government, Abbas Ali Khan said
the Jamaat supported the BNP to
remove political stalemate and
form people's government but it
was not going to share In the
present failure of the government.
—Shaju Sardar
Sunday Express 05
WAVE OF DEATH [~~
Cry F©tr Co-ordination:
NG0s Are Ift Shambles
The waves of death
continue to appear in this
land with all their crudity
and diversity. At this
hours of disaster and
distress, the government,
as it has already
appeared, alone cannot
cope with the situation.
The non-governmental
organisations, popularly
known as NGOs, the past
experiences say, can
supplement the efforts. In
what ways? Could they
rise to the occasion
properly and effectively?
Farhad Mazhar writes:
The hotly debated issue in the NGO para
now is co-ordination "A cry for urgent and
effective co-ordination among NGOs" was
the bold caption of a letter written on 4th of
May by Md. Saidur Rahman. Country
Representative of Oxfam-UK
to his
colleagues . The language of the letter was
moving and mingled with emotion and
frustration. Saidur wrote, "NGOs immediate
intervention to save human lives is slow and
very poor. As of pm of May 3rd. almost 90
hours after the cyclone struck the coast.
only two organisation started food
distribution in Hatiya and four in Chittagong
and Cox's Bazar areas. Large number of
worst hit areas have not yet been reached".
In the evening of 4th of May I was in
Chokoria. From the Red Crescent and other
local sources I was told that executives of
BRAC and CARITAS was in the area but no
relief operation had began until then. On 5th
I was in Kutubdia and Mongnama. According
to Mr. Shahabuddin, UNO of Kutubdia, EDM
was planning to distribute terpaulins for
housing. I categorically asked him about
other NGOs. He could not give me any other
names.
In Mongnama I saw Gonoshasthaya
Sunday Express 06
Kendra’s jute relief bag in the hands of the
people. Two soldiers who were engaged in
mobilizing people to bury the dead bodies
and the carcasses told me that they had to
help Gonoshasthaya relief team because
local Union Chairman and members were
creating tension in food distribution. The
road from Chokoria to Pekua is good for
vehicle. To reach Mongnama any relief team
Farhad Mazhar
would have to walk tor 4 to 5 kilometers from
Pekua. It is difficult but not at all impossible.
That means, if any NGO had the will to run
the relief operation in Chokoria-Mongnama
area, one of the worst affected spots, there
was no reason why they could not do so
Inaccessibility to affected areas and lack
of communication was excuses for many
large NGOs to avoid their responsibility and
social commitment. Many had resources to
mobilize immediately but did not move until
they got financial commitments from their
respective donors. A slow and poor
response is a sign of inefficiency and lack of
will Saidur Rahman is correct. NGOs are
indeed guilty of not intervening in time to
save human lives.
In an ADAB meeting Khushi Kabir of
Nijera Kan also expressed her deep concern
over the poor NGO to NGO co-ordination. A
bit of realization of the massive destruction
caused by the unprecedented cyclone
should force any one to come closer to
others to join in hands to face the tragedy
collectively. The spirit was not there. The
fetish of the paid voluntarism is taking its
revenge.
Saidur Rahman gave a few examples to
demonstrate the nature of non-coordination.
There is a terrible lack of information sharing
among the NGOs. NGOs often take pride in
their professionalism. But listen to what
Saidur Rahman had to say:
”.......NGOs didn't know where to
go, how to go, what to buy, where to
buy from, how to transport the
materials etc etc. Many NGO’s
don't have the latest situation
report of the disaster. They don’t
have the information of who have
gone
where,
what
resources
mobilised for which area, where to
make pool of resources with small
contribution from small NGO’s etc.
etc.”
These cnticisms are extremely serious.
Lack of professionalism also costing
valuable resources received from the
donors. Chira (pressed rice) was bought on
1st May at the rate of Tk.800 per bag of
55Kg. Soon the markets of Kowran Bazar
and Moulvi Bazar shot the price up to
Tk1350. But it was still available at Tk 800
rate from factories of Tongi, Joydevpur, c
Narayanganj and Munshiganj Similarly
cost of transport also went up
unnecessarily. A truck which was hired at
the rate of Tk. 2,300 from Dhaka to
Chittagong was paid Tk. 6,500 by a foreign
agency.
While Saidur Rahman's agony should be
appreciated as a self-criticism of the NGO
community it is important to look deeper
into the problem. NGO community is not a
homogeneous body. Besides being divided
by size and their connection to different
types of donors there are serious division
among them in terms of philosophical
outlook and developmental practices.
Indeed lack of co-ordination does not
mean much unless we identify the cause. If
an NGO refuses to co-ordinate with another
NGO because of the latter's lack of social
commitment and insensitivity to
community's need there is nothing wrong in
it. If an NG6 strongly believes that a
disaster can be realistically managed only «
by involving the community to mobilize the *1
popular spirit and organizational
capabilities inherent in its social
mechanism, there will definitely be conflict
with this NGO with others who want to face
disaster or conduct development activities
with well paid "volunteers” who receive per
diem while working out of station. These
conflicts at the level of commitment and
philosophy cannot be compromised but
only dialectically resolved through
ideological and practical struggle.
The hidden wound of deepest conflict at
the level of ideology and approach to
development activities manifested openly
when a group of NGO leaders used the
I
jrmoiil during the period of other hand it is not difficult to understand contributed further to its deterioration.
Given these realities I seriously doubt
I to remove their opponent from that there is essentially no difference in
anshiip of ADAB. In a meeting
terms of class aspiration between the the possibility of any effective
of
six members of the Ershad's Jatiya Party, Hasina's Awami co ordination among the NGOs. But in the
atiom Sub committee of ADAB League and Khaleda's BNP. As an NGO face of the massive devastation caused
that the removal was “illegal". there is no glory in supporting Awami League by the 29 April surge NGOs will perform
badly unless they repair the shamble they
of this illegal removal to punish or BNP.
nt wvill be remembered as the
Nevertheless in the name of are plunged into now. There are already
tory of NGO movement in this "pro-democracy" movement the present serious doubts raised whether the NGO
nsrsally in the eye of the masses leaders of ADAB had explicitly taken sides community can at all manage a massive
;eem as a negative force, agents with political parties who were in opposition relief and rehabilitation programme which
powvers to dominate and control movement The principal of non-partisanship donors are demanding from them. One of
/ amd resources. While there are had been openly violated for the sake of my faint hope is that the present
orctes of domination active in personal image. NGO leaders were perhaps leadership of ADAB can take full
i the general negative view of nervous about their past relationship with advantage of the current situation and will
as an enemy of the people is the Ershad regime. They thought sacrificing repair the wound to a point where at least
rtuinate. The NGO
operational co-ordination can be
niever clarified, or
established. We must save human
veir wanted to clarify
lives at this moment without losing
It will be quite positive indeed if
e and role in the
time as rightly expressed in Saidur
different NGOs come close into groups
9 eevent of ADAB has
Rahman's concern.
according to their ideological affinity
lisl.hed the image of
But for the long term NGOs
h will take long time
must rethink seriously whether
and
working
patterns
to
plan
and
9dd
they at all need a central
execute a collective relief and
GiOs must have
co-ordinating body like ADAB.
colarity of what
NGOs must be allowed to form
rehabilitation programme.
doing. Whether
different consortia and groups on
ctonscious of the
the basis of their philosophical
aispects of their
dispositions and nature of work.
or are insensitive and one of their colleagues as the only There is nothing wrong to have two or three
this respect or not,
"collaborator" with E<shad regime will clean consortia, groups, networks, federations
mental
activities
are them all. They were so afraid of the etc. who can co ordinate among
EBut what distinctly places opposition movement that they wanted to themselves. Let there be many
cove the partisan politics erase all traces of collaboration. It was a co-ordinating bodies and networks This is
they
must
remain naive political opportunism. A movement can an area where donors must think seriously
san. Political content of not be democratic just because it is as well because they often uncritically
>• lies in the philosophical opposing a government and demanding assume that the presence of a structure
and the nature of the removal of a person unless
a clear like ADAB is complementing to the
e institutions with regard democratic transformation is posited in the development activities of Bangladesh.
lation with the civil society slogans and the political programmes. The The reality points to the opposite.
state. Unlike political parties change of the government in December left
In many cases to face the disaster of
3 not instruments to capture untouched the whole undemocratic structure the 29 April NGOs in groups are
wer. Their relation with the state of the state as had been anticipated The co-operating among themselves without
government is based on the existing
NGO leaders of ADAB the mediation of ADAB. These are
3f non-partisanship. They can demonstrated very poor political wisdom and symptomatic of newer possibilities and
differ with the government with had risked to divide the NGO community must not be hindered in the name of a
i specific policy or approach In only to remove one of their colleagues from central co-ordination which no one can
ct work of the NGOs must be ADAB without going deep into their real assure now. It will be quite positive indeed
the basis of the content of a difference and the question of their clear if different NGOs come close into groups
are supporting or opposing.
stand for popular democracy. The trend of according to their ideological affinity and
principle present leaders of
political opportunism to knock the opponent working patterns to plan and execute a
ported and collaborated with the dunng confusing political events for vested collective relief and rehabilitation
overnment and the existing interest has further complicated the programme.
ureaucratic state on many relationship among the NGOs. It was indeed
Only a cohesive group can plan,
in the sphere of khas land a terrible experience for many who were execute and co ordinate their activities in
i, cluster village formation. EPI concerned about the developmental an efficient and professional manner.
9, ORS distribution, etc. The list movement in Bangladesh.
Unnecessary time should not be wasted to
anded. I see nothing wrong in this
The criticism of ADAB is nothing new. co-ordinate at a level which has been
ion and NGOs -must not be Many persons expressed serious doubt rendered impossible by the NGOs
I by the vested political interest privately or publicly about the utility of this themselves. - 11 May, 1991
>port a pro-people policies like organization and its ability to perform what
Health policy or others. On the one expects them to do The nature of the
present conflict between NGOs has
Sunday Express 07
WAVE OF DEATH
Cry
___________________________________________
C@-ordineats©s
1
NGOs Are In Shambles
The waves of death
continue to appear in this
land with all their crudity
and diversity. At this
hours of disaster and
distress, the government,
as it has already
appeared, alone cannot
cope with the situation.
The non-governmental
organisations, popularly
known as NGOs, the past
experiences say, can
supplement the efforts. In
what ways? Could they
rise to the occasion
properly and effectively?
Farhad Mazhar writes:
The hotly debated issue in the NGO para
now is co-ordination. "A cry for urgent and
effective co-ordination among NGOs” was
the bold caption of a letter written on 4th of
May by Md. Saidur Rahman, Country
Representative of Oxfam-UK
to his
colleagues . The language of the letter was
moving and mingled with emotion and
frustration. Saidur wrote, ’NGOs immediate
intervention to save human lives is slow and
very poor. As of pm of May 3rd, almost 90
hours after the cyclone struck the coast,
only two organisation started food
distribution in Hatiya and four in Chittagong
and Cox's Bazar areas. Large number of
worst hit areas have not yet been reached".
In the evening of 4th of May I was in
Chokoria. From the Red Crescent and other
local sources I was told that executives of
BRAC and CARITAS was in the area but no
relief operation had began until then. On 5th
I was in Kutubdia and Mongnama. According
to Mr. Shahabuddin, UNO of Kutubdia, EDM
was planning to distribute terpaulins for
housing. I categorically asked him about
other NGOs. He could not give me any other
names.
In Mongnama I saw Gonoshasthaya
Sunday Express 06
Kendra’s jute relief bag in the hands of the
people. Two soldiers who were engaged in
mobilizing people to bury the dead bodies
and the carcasses told me that they had to
help Gonoshasthaya relief team because
local Union Chairman and members were
creating tension in food distribution The
road from Chokoria to Pekua is good for
vehicle. To reach Mongnama any relief team
have the information of who have
gone
where,
what
resources
mobilised for which area, where to
make pool of resources with small
contribution from small NGO’s etc.
etc.”
These criticisms are extremely serious.
Lack of professionalism also costing
valuable resources received from the
donors Chira (pressed rice) was bought on
1st May at the rate of Tk.800 per bag of
55Kg Soon the markets of Kowran Bazar
Farhad Mazhar
and Moulvi Bazar shot the price up to
Tk1350. But it was still available at Tk.800
would have to walk tor 4 to 5 kilometers from rate from factories of Tongi, Joydevpur, e;
Pekua It is difficult but not at all impossible Narayanganj and Munshiganj Similarly
That means, if any NGO had the will to run cost of transport also went up
the relief operation in Chokoria-Mongnama unnecessarily A truck which was hired at
area, one of the worst affected spots, there the rate of Tk. 2,300 from Dhaka to
was no reason why they could not do so.
Chittagong was paid Tk 6,500 by a foreign
Inaccessibility to affected areas and lack agency.
of communication was excuses for many
While Saidur Rahman’s agony should be
large NGOs to avoid their responsibility and appreciated as a self-criticism of the NGO
social commitment. Many had resources to community it is important to look deeper
mobilize immediately but did not move until into the problem. NGO community is not a
they got financial commitments from their homogeneous body. Besides being divided
respective donors. A slow and poor by size and their connection to different
response is a sign of inefficiency and lack of types of donors there are serious division
will. Saidur Rahman is correct, NGOs are among them in terms of philosophical
indeed guilty of not intervening in time to outlook and developmental practices.
save human lives.
Indeed lack of co-ordination does not
In an ADAB meeting Khushi Kabir of mean much unless we identify the cause. If
Nijera Kan also expressed her deep concern an NGO refuses to co-ordinate with another
over the poor NGO to NGO co-ordination. A NGO because of the latter’s lack of social
bit of realization of the massive destruction commitment and insensitivity to
caused by the unprecedented cyclone community’s need there is nothing wrong in
should force any one to come closer to it. If an NGO strongly believes that a
others to join in hands to face the tragedy disaster can be realistically managed only
collectively. The spirit was not there. The by involving the community to mobilize the
fetish of the paid voluntarism is taking its popular spirit and organizational
capabilities inherent in its social
revenge.
Saidur Rahman gave a few examples to mechanism, there will definitely be conflict
demonstrate the nature of non-coordination. with this NGO with others who want to face
There is a terrible lack of information sharing disaster or conduct development activities
among the NGOs. NGOs often take pride in with well paid "volunteers" who receive per
their professionalism. But listen to what diem while working out of station. These
conflicts at the level of commitment and
Saidur Rahman had to say:
philosophy cannot be compromised but
".......NGOs didn't know where to only dialectically resolved through
go, how to go, what to buy, where to ideological and practical struggle.
The hidden wound of deepest conflict at
buy from, how to transport the
materials etc etc. Many NGO’s the level of ideology and approach to
don't have the latest situation development activities manifested openly
report of the disaster. They don't when a group of NGO leaders used the
political turmoil during the period of other hand it is not difficult to understand contributed further to its deterioration.
Given these realities I seriously doubt
Ershad’s fall to remove their opponent from that there is essentially no difference in
terms of class aspiration between the the possibility of any effective
the Chairmanship of ADAB. In a meeting
five out of six members of the Ershad’s Jatiya Party, Hasma's Awami co-ordination among the NGOs. But in the
Self-Regulation Sub committee of ADAB League and Khaleda's BNP. As an NGO face of the massive devastation caused
expressed that the removal was "illegal". there is no glory in supporting Awami League by the 29 April surge NGOs will perform
badly unless they repair the shamble they
The drama of this illegal removal to punish or BNP
’
an opponent will be remembered as the
Nevertheless in the name of are plunged into now. There are already
darkest history of NGO movement in this “pro-democracy" movement the present serious doubts raised whether the NGO
country Generally in the eye of the masses leaders of ADAB had explicitly taken sides community can at all manage a massive
NGOs are seen as a negative force, agents with political parties who were in opposition relief and rehabilitation programme which
of external powers to dominate and control movement The principal of non-partisanship donors are demanding from them. One of
their society and resources While there are had been openly violated for the sake of my faint hope is that the present
definitely forces of domination active in personal image. NGO leaders were perhaps leadership of ADAB can take full
Bangladesh the general negative view of nervous about their past relationship with advantage of the current situation and will
the NGOs as an enemy of the people is the Ershad regime. They thought sacrificing repair the wound to a point where at least
operational co-ordination can be
quite unfortunate. The NGO
established. We must save human
community never clarified, or
lives at this moment without losing
perhaps never wanted to clarify
It will be quite positive indeed if
time as rightly expressed in Saidur
their image and role in the
different NGOs come close into groups
Rahman's concern.
society. The event of ADAB has
according to their ideological affinity
But for the long term NGOs
further tarnished the image of
must rethink seriously whether
NGOs which will take long time
and working patterns to plan and
they at all need a central
to be repaired.
execute a collective relief and
co-ordinating body like ADAB.
The NGOs must have
NGOs must be allowed to form
political clarity of what
rehabilitation programme.
different consortia and groups on
they are doing. Whether
the basis of their philosophical
they are conscious of the
dispositions and nature of work.
political aspects of their
activities or are insensitive and one of their colleagues as the only There is nothing wrong to have two or three
"collaborator" with Ershad regime will clean consortia, groups, networks, federations
naive in this respect or not,
developmental
activities
are them all. They were so afraid of the etc. who can co ordinate among
political. But what distinctly places opposition movement that they wanted to themselves. Let there be many
NGOs above the partisan politics erase all traces of collaboration. It was a co-ordinating bodies and networks. This is
is
that
they
must
remain naive political opportunism. A movement can an area where donors must think seriously
non-partisan. Political content of not be democratic just because it is as well because they often uncritically
the NGOs lies in the philosophical opposing a government and demanding assume that the presence of a structure
position and the nature of the removal of a person unless
a clear like ADAB is complementing to the
respective institutions with regard democratic transformation is posited in the development activities of Bangladesh.
to the relation with the civil society slogans and the political programmes. The The reality points to the opposite.
and the state. Unlike political parties change of the government in December left
In many cases to face the disaster of
NGOs are not instruments to capture untouched the whole undemocratic structure the 29 April NGOs in groups are
political power. Their relation with the state of the state as had been anticipated. The co-operating among themselves without
and the government is based on the existing
NGO leaders of ADAB the mediation of ADAB These are
principle of non-partisanship. They can demonstrated very poor political wisdom and symptomatic of newer possibilities and
support or differ with the government with had risked to divide the NGO community must not be hindered in the name of a
regard to a specific policy or approach. In only to remove one of their colleagues from central co-ordination which no one can
this respect work of the NGOs must be ADAB without going deep into their real assure now. It will be quite positive indeed
judged on the basis of the content of a difference and the question of their clear if different NGOs cdme close into groups
policy they are supporting or opposing.
stand for popular democracy. The trend of according to their ideological affinity and
On this principle present leaders of
political opportunism to knock the opponent working patterns to plan and execute a
ADAB supported and collaborated with the during confusing political events for vested collective relief and rehabilitation
Ershad government and the existing interest has further complicated the programme.
Only a cohesive group can plan,
military-bureaucratic state on many relationship among the NGOs. It was indeed
occasion in the . sphere of khas land a terrible experience for many who were execute and co ordinate their activities in
distribution, cluster village formation. EPI concerned about the developmental an efficient and professional manner.
Unnecessary time should not be wasted to
programme, ORS distribution, etc. The list movement in Bangladesh.
The criticism of ADAB is nothing new. co-ordinate at a level which has been
can be extended. I see nothing wrong in this
collaboration and NGOs -must not be Many persons expressed serious doubt rendered impossible by the NGOs
• intimidated by the vested political interest privately or publicly about the utility of this themselves. -11 May, 1991
not to support a pro-people policies like organization and its ability to perform what
Drug policy, Health policy or others. On the one expects them to do The nature of the
present conflict between NGOs has
Sunday Express 07
Now tornado causes havoc
3
Nature seems to have chosen
Bangladesh, the largest delta in
the world as the target of
ventilating her wrath in recent
times. With the nation still writhing
due to the aftershock of cyclone
and tidal bore of April 29 that left a
trail
of devastation,
another
tornado has hit Gazipur, 28
kilometers from Dhaka on May 7.
Sunday Express correspondent
Iftekhar Hassan has filed the
following
report
after
an
on-the-spot survey in the affected
area.
tin-sheds were seen flying like
pieces of paper. The tornado
weakened after causing extensive
were completely destroyed. The
villages over which the tornado
passed bear testimony to the
$
On May 7 at around six in the
evening a devastating tornado hit
the
villages
Naojor,
Vogra,
Sharifpur,
Adepasha,
Jhajar,
Vegerchala, Polagach, Chhoidana,
Hyderabad, Khailkur of Gazipur
district. So far fortyfive deaths have
been reported. More than five
hundred people were injured. With
many of them in critical condition
the death toll may further rise. '
According to the eye-witnesses
on that fateful evening wind at
great velocity started blowing from
the south. It stopped for a while.
The sudden toll was followed by
black funnel of smoke swirling in at
great speed. The guests and
squalls were accompanied with
hails and heavy downpour. Trees
were uprooted. Walls fell and
Sunday Express 08 ,
Tornado that swooped with demonic destructive forces
on May 7
left 90 percent of mud-walled houses
levelled to the ground and also the girl (flanked by two
women) orphanejd in Gazipur.
damage in a radius of 7/8 miles. destruction of the tornado. The 15"
The destructive power of the to 20" thick mud walls of most of
tornado was umbelievable. ' An the dwelling houses were levelled
under-construction
ceramic by the storm. In Sharifpur, six from
industry was turned into a heap of one family were killed when the
rubble.
The
fifteen
crore walls of a house collapsed. Seven
taka-industry was supposed to people from one family in Jhajhar
start working from June. Apart village died in the same manner.
from this a drug manufacturing Police, Fire Service with the help
industry and Green Metal Industry •.from local people started rescue
WAVEOFDEATH
• «
•
••
•
•
• • • .
•
• ••*•*•• • . . a
«•
•
9• r
9
•
9 J F ’•* • ’ •
operation at around seven thirty.
Army came in the scene at ten.
Specially, Fire Servicemen earned
everyone's praise for their work.
The tornado has robbed sixteen
thousand people of more than
three thousand families of sixteen
villages of their means of living.
These people with no shed over
their head are suffering from the
scorching sun and rain and living
a subhuman life at the moment.
-Iftekhar Hassan
Standard Ceramic crumbled like house of cards. Tornado was
the cause. Was that all? Or, defective construction to the neglect
of design criteria, wind speed and earthquake could have
anything to do? Imagine if people were there.
Commentary
Hajj vs help for
cyclone victims
"The flesh of them (of sacrificed animals)
shall not reach God, neither their blood, but
godliness (sincerity & devotion) from you shall
reach Him." || Al Quran. (22;37). This is how
Islam looks at the things.. If anyone truly
follows the Quranic teachings, he finds hardly
any difficulty in setting before him the
priorities. And what priorities at a time when
the nation is passing through one of its worst
and seveiest crises?
Religious sermons are however often
misinterpreted only because that way things
suit the traders of religions. Good men and
poets in particular have always held man and
man alone above every other things. In its
unmitigated sufferings, the nation should,
more than at any other times, come to grapple
with this reality.
If doing good to people is anybody’s aim
and be one favoured with God, he has an
opportunity before him. Performing Hajj surely
earns for a Muslim God’s blessings, but at this
time of human distress serving the cause of
humanity will be even more divinely rewarded
(earn ’sawab’). And there exactly we feel
tempted to offer a suggestion. If the
prospective Hajis decided not to perform Hajj
his year and instead went themselves or their
representatives to the affected areas to help
one or two families by building their houses
and also providing them with other means of
living, God would perhaps have been more
pleased than perhaps if they visited the holy
shrine. Will the men and women intending to
visit Makkah follow the man from Baghdad-as
quoted by Imams-- who donated all his
painfully saved money to his neighbours who
were eating rotten meat after days of
starvation?
Stretch the idea and you can help without
slaughtering animals on the occasion of
Eid-ul-Azha at least this year. The benefit is
double by way of sparing the already
precariously reduced number of cows and
oxen and also diverting the money so saved
for the alleviation of sufferings of the cyclone
affected people. Instead of slaughtering
animals, give them to the people who have
lost all their draft animals and milch cows. #
Sunday Express 09
Now tornado causes havoc
Nature seems to have chosen
Bangladesh, the largest delta in
the world as the target of
ventilating her wrath in recent
times. With the nation still writhing
due to the aftershock of cyclone
and tidal bore of April 29 that left a
trail
of devastation,
another
tornado has hit Gazipur, 28
kilometers from Dhaka on May 7.
Sunday Express correspondent
Iftekhar Hassan has filed the
following
report
after
an
on-the-spot survey in the affected
area.
tin-sheds were seen flying like
pieces of paper. The tornado
weakened after causing extensive
were completely destroyed. The
villages over which the tornado
passed bear testimony to the
I
On May 7 at around six in the
evening a devastating tornado hit
the
villages
Naojor,
Vogra,
Sharifpur,
Adepasha,
Jhajar,
Vegerchala, Polagach, Chhoidana,
Hyderabad, Khailkur of Gazipur
district. So far fortyfive deaths have
been reported. More than five
hundred people were injured. With
many of them in critical condition
the death toll may further rise.
According to the eye-witnesses
on that fateful evening wind at
great velocity started blowing from
the south. It stopped for a while.
The sudden toll was followed by
black funnel of smoke swirling in at
great speed. The guests and
squalls were accompanied with
hails and heavy downpour. Trees
were uprooted. Walls fell and
Sunday Express 08 <
Tornado that swooped with demonic destructive forces
on May 7
left 90 percent of mud-walled houses
levelled to the ground and also the girl (flanked by two
women) orphaneid in Gazipur.
damage in a radius of 7/8 miles.
The destructive power of the
tornado was umbelievable. * An
under-construction
ceramic
industry was turned into a heap of
rubble.
The
fifteen
crore
taka-industry was supposed to
start working from June. Apart
from this a drug manufacturing
industry and Green Metal Industry
destruction of the tornado. The 15"
to 20" thick mud walls of most of
the dwelling houses were levelled
by the storm. In Sharifpur, six from
one family were killed when the
walls of a house collapsed. Seven
people from one family in Jhajhar
village died in the same manner.
Police, Fire Service with the help
from local people started rescue
operation at around seven thirty.
Army came in the scene at ten.
Specially, Fire Servicemen earned
everyone's praise for their work.
The tornado has robbed sixteen
thousand people of more than
three thousand families of sixteen
villages of their means of living.
These people with no shed over
their head are suffering from the
scorching sun and rain and living
a subhuman life at the moment.
—Iftekhar Hassan
Standard Ceramic crumbled like house of cards. Tornado was
the cause. Was that all? Or, defective construction to the neglect
of design criteria, wind speed and earthquake could have
anything to do? Imagine if people were there.
Commentary
Hajj vs help for
cyclone victims
'The flesh of them (of sacrificed animals)
shall not reach God, neither their blood, but
godliness (sincerity & devotion) from you shall
reach Him." - Al Quran. (22;37). This is how
Islam looks at the things.. If anyone truly
follows the Quranic teachings, he finds hardly
any difficulty in setting before him the
priorities. And what priorities at a time when
the nation is passing through one of its worst
and severest crises?
Religious sermons are however often
misinterpreted only because that way things
suit the traders of religions. Good men and
poets in particular have always held man and
man alone above every other things. In its
unmitigated sufferings, the nation should,
more than at any other times, come to grapple
with this reality.
If doing good to people is anybody’s aim
and be one favoured with God, he has an
opportunity before him. Performing Hajj surely
earns for a Muslim God’s blessings, but at this
time of human distress serving the cause of
humanity will be even more divinely rewarded
(earn ’sawab’). And there exactly we feel
tempted to offer a suggestion. If the
prospective Hajis decided not to perform Hajj
his year and instead went themselves or their
representatives to the affected areas to help
one or two families by building their houses
and also providing them with other means of
living, God would perhaps have been more
pleased than perhaps if they visited the hob/
shrine. Will the men and women intending to
visit Makkah follow the man from Baghdad-as
quoted by Imams- who donated all his
painfully saved money to his neighbours who
were eating rotten meat after days of
starvation?
Stretch the idea and you can help without
slaughtering animals on the occasion of
Eid-ul-Azha at least this year. The benefit is
double by way of sparing the already
precariously reduced number of cows and
oxen and also diverting the money so saved
for the alleviation of sufferings of the cyclone
affected people. Instead of slaughtering
animals, give them to the people who have
lost all their draft animals and milch cows. #
Sunday Express 09
WAVE OF DEATH
What to do in a disaster:
A personal Account
By A Disaster Management Expert
STARTING ON THE FOURTH OF MAY.
1991 •
I started for Chittagong on Saturday
morning of the fourth May in a jeep with
Saleha behind the wheel. Desperate hours
were spent after the cyclone had hit the
coastal belts of Bangladesh to collect
information about the worst affected
areas. It was extremely hard to pick up
hints about the state of communication. At
a point it seemed that inaccessibility to
the affected areas has been taken for
granted. The most vital information one
needs immediately after a disaster is how
to reach the affected area with relief and
medical supplies. Unfortunately that
information was lacking.
Mohammed Zakaria, member of the
Board of Trust of GK, Farhad Mazhar of
UBINIG, Mohammed Shafiuddm of
Gonokalyan Trust and Md. Shiraz of SEDS
accompanied me on this trip. It was a
collective exercise to plan and operate the
relief and rehabilitation.
GKT and SEDS are active in Satuna.
UBINIG is a wellknown organization
involved in research, advocacy and
education on developmental issues.
UBINIG has a programme with the poor
community of the prawn seed collectors of
Badarkhali for the last two years which is
one of the worst affected areas.
Mohammed Zakaria was trying to
arrange a ship to carry materials to
Kutubdia and other affected areas. A large
vessel was necessary to carry food,
medical supplies and water. That would
have been ideal, but it was difficult to
arrange.
• BANK WAS CLOSED
A HINDRANCE T.Q.RELIEE PREPARATION
Our preparation for a massive and
quick response had been seriously
hindered due to the fact that the first of
May was a national holiday. No Bank was
open on that day. The following day was
Sunday Express 10
Thursday, bank operation was open only for
the half of the day to be closed again till the
next Saturday morning It was difficult to
Dr. Zafrullah Chowdhury
mobilize fund and therefore the necessary
purchase of relief materials was hampered.
It manifests the lack of political will to face a
disaster of such a massive magnitude.
From Feni onward the devastating effects
of the cyclone was visible On our way we
did not meet any vehicle or truck that shows
any sign of relief activities However, shortly
after Mirersharai we met two youth groups
belonging to Islami Chattra Shibir raising
funds for the distressed In a Bazaar before
the BNP office there was also a small group
of 5 to 6 people raising money. They
obviously belonged to BNP. We met no other
political groups or organizations on our way
to Cox's Bazar.
SHARIF & HIS TEAM: A GOOD SOURCE
OF VITAL INFORMATION
materials till then. GK relief medical team
had already started working and planned
their operation on the basis of the
information available to Red Crescent
and other sources Here we first came to
know that relief trucks can go upto
Pekua and from there one can walk 3 to
4 kilometers to Mongnama which is badly
affected It therefore was not at all
impossible to distribute food and water in
this badly affected area.
When we reached Cox's Bazar it was
already nine in the evening. We went
straight to Red Crescent Office to meet
the project .officer Sk Sharif Ahmed.
Sharif is an excellent and active person
with the right kind of information one
needs to plan a relief operation in his
area
He briefed us about the
devastation on the map of Cox's Bazar
hanging from his wall. Here we also
noticed the discrepancy between the
government figure of deaths with the
figures of Red Crescent. We also
informed by Sharif that some of the
information of the media was not correct
For example, Inqilab, a national daily
reported that there is no one alive in
Sonadia. This is completely wrong
Sonadia was not at all severely affected
in terms of loss of life.
Shanf is familiar with GK and its mode
of operation To help us concretize our
logistics, he offered to accompany us
next morning with his 90 horsepower
speedboat which he navigates himself.
We planned to cover as much area as we
From Chittagong we picked up Mianbhai,
a friend of ours and a wellknown social
worker. He took us to Bangla Bazar to see a
barge and a ship thrown on the bank of
Karnaphuli by the cyclone. Massive
devastating power of the
Cyclone was obvious.
Our preparation for a massive and quick
We reached Chokoria
slightly before seven in the
response had been seriously hindered due to
evening. It was already dark.
the fact that the first of May was a national
We met the relief team of
holiday. No Bank was open on that day. The
Gonoshasthaya Kendra before
the Upazilla Office. Two
following day was Thursday, bank operation
medical teams had already
was open only for the half of the day to be
started
operating
and
closed again till the next Saturday morning. It
preparation was taken to start
food distribution from the early
was difficult to mobilize fund and therefore *
next morning.
the necessary purchase of relief materials
The field officer of Red
Crescent at Chokoria informed
was hampered. It manifests the lack of
us that he met with the people
political will to face a disaster of such a
from BRAC and CARITAS but
they had not brought any relief
massive magnitude.
could including Kutubdia. Masaaki Ohashi,
delegate of League of Red Cross and Red
Crescent Societies was scheduled to visit
the affected areas. Sharif tagged us with
that trip.
Sharif had already started to distribute
relief bags and emergency nutritional
rations on the basis of his available supply.
In Cox’s Bazar and adjacent areas 50,
Kutubdia 400, Moheshkhali 300 and
Chakoria150 relief bags were distributed by
that day (4th of May) . Each relief bag
contained 5kg of rice. 800Kg of pulse.
100gm salt, one matchbox and one candle.
Besides the food bags 15 and 30 nutritional
ration were distributed in Kutubdia and
Moheshkhali The nutritional ration is known
as BP 4 Norwegian biscuits. It contains four
230gm compressed bars each of 1000 Kcal.
The nutritional-composition is as follows:
protein 17.5%
fat 12%
carbohydrate 65%
Vitamin/mineral added.
Before we finished for the day Farhad
went out to meet the leaders of Abhigyan
Bigyan Kendra, a local organisation of
students. We needed to organize roti
production Therefore the community must
be encouraged to participate. The women
also must be mobilized. The group was quite
enthusiastic about roti production. Next day
we all met members of Abhigyan Biggan
Kendra and explained what we intended to
do and it should be planned. In the mean
time we also told them to look for if we can
rent a bakery in Cox's Bazar to produce the
nutritional biscuits which Gonoshasthay
has recently formulated The group were
also asked to provide us with necessary
information about transportation, trawlers
and price of the necessary commodities.
We divided ourselves into three groups.
Two went back to Chittagong Shafi and
Shiraz went to Chokona to meet with the GK
group operating there. Through Pekua they
will try to reach Mongnama. Farhad
accompanied me in Shanf's speedboat.
DESCRIBING THE EXPERIENCE
Next day (5th May) Sharif navigated the
speedboat explaining the state of
devastation while he was passing an area.
We stopped at Dhalghata and Matarbari of
Moheshkhali which was severly affected.
The dead bodies and carcasses were still
visible. According to Sharif 7000 out of
10,000 of the population are dead or
missing in Matarbari. As far as the eye
could go there was no house except two
broken buildings by the bank. One of the
broken brick structures was the salt
crushing factory, the largest in the area. We
spoke with a person of the salt factory who
came to the bank noticing the speed boat
approaching the shore. He said production
cannot be restored until next season. In the
mean time the machineries will be repaired
and necessary
preparation to launch
production during the next season will be
undertaken.
We enquired about the drinking water.
Despite the terrible state of the situation it is
not unavailable. Obviously in most cases
one has to walk a long way to reach a tube
well. But there are no sweet water available
for cleaning and washing. The stagnant salt
water polluted with caracasses and dead
bodies has already become a serious health
hazards for those who are still alive.
We steered by a small island named
Kanardia. There is no tubewell in this island.
It never had one.
Our next stop was at Ujantia where Red
Crescent has a cyclone shelter. Here we met
Jasimuddm Chowdhury, a Red Crescent
volunteer. According to Jasim there are
three thousand persons in the shelter. Until
then he had received 8 bags of nee and 23
bags of chira (puffed rice). A medical team is
also stationed here. Supply of medicine is
not sufficient. Apart from that the doctor has
shown us a container of paracetamol
contaminated, supplied from abroad, by
fungal growth.
It was an important realization for us that
the cyclone shelter had not only saved the
lives but was also providing a roof for many.
It is often criticized as an useless vacant
structure. Local people said that the last
cyclone they saw was back in nineteen
sixtyfive The structure of the-cyclone
shelter has proved its utility after more than
25years
Throughout whole journey, we found large
number of dead animals. I counted over 170
in one hour journey. We next stopped at
Kutubdia. There were still unburied
human bodies lying between the
piles of dead livestocks. The acute
rotten smell of decomposed human
and animal flesh has made the air
putrid and heavy. People around us
seemed
to
have
been
quite
accustomed to the scene and the
smell. The experience evokes an
absurd experiential state to the
point of a surrealistic numbness as
if we lost all our senses.
Amid the debris what had brought us back
to human emotion is the body of a little girl
holding the rope of her goat tightly in her
hand. One can easily visualise how she
struggled hard to save her loving creature.
an important member of her life. The relation
of the rural population with their livestocks is
extraordinarily intimate and human. It is
important to note that a cursory assessment
can tell that more than 95 percent of the
livestock and the poultry have been
destroyed in the cyclone.
From the steamer ghat we took a rickshaw
to go to the Upazilla town. Bashar, the
rickshawpuller, used to work in Chittagong
as a baby taxi driver. He returned to
Kutubdia to join his family during cyclone.
but in the last moment he was separated
from the family by cyclone and tidal waves
Next morning he realised that 17 persons of
his family are either dead or missing. He
came back only a day before on 3rd of May
What had immeditaly impressed us is his
enormous courage and emotional stamina to
face the cruelty of nature and life. He is not
waiting for relief or help from outside.
Immediately on the road with a rickshaw to
earn for the survivers of his family whom he
does not want to leave, now he is back in
Kutubdia.
Bashar forced the frame of our
perspective to turn completely in a different
direction. The post-disaster reality
must be seen from the perspective
of the
struggling courage of the
people. Therefore when we were passing
through the devastated bazar we saw the life
buzzing again with all its charm, despite the
fact that except a few brick constructions
there is no roof or house in the bazar. This
was once a crowded bazar, almost ever/ one
walking or moving around us had lost dear
members of the family. The feeling that we
were going through a holocaust amid the
piles of debris started to disappear when we
noticed people already busy selling foods
and necessary commodities. By the road
side a group of people were squated around
a tea shop. Bashar stopped his Rickshaw
there and we ordered tea and poagula .
Poagula, a local cake produced from flour
and fried on oil. It was hot and tasty. Farhad
tried to pronounce the name of the cake in
local dialect and every one laughed at his
poor performance. The tea was served
without milk, but it was alright.
Next to the poagula tea shop little Sagira,
a girl of hardly 11 years old was selling roti
made of nee flour. She is selling roti sitting at
the same place where her father had a shop.
Except her mother rest of the 8 member
family was missing or dead. She will now take
care of her mother earning money by selling
roti.
At the Red Crescent Office we learned
more about the magnitude of devastation.
Asadullah Khan, the Red Crescent
Sunday Express 11
field officer has informed us that
he had lost 103 persons among his
family and kins. All the unions of
Kutubdia was severely devasted. However
the devastation and the death toll of Ali
Akbar Dail was the highest. Seventy
percent or more of the population of Khudiar
Tek belonging to this Union are either dead
or missing. According to the estimate of the
Red Crescent volunteers on the average 25
to 30 percent of the population of Kutubdia
are lost or dead.
Afterwards we went to meet Mr.
Shahabuddin Ahmed, the Upazilla Nirbahi
Officer(UNO). While we were entering
Upazilla compound we saw army were
preparing to distnbute relief and people were
gathering around the Upazilla building.
According to the estimate of Mr. Ahmed,
40,000 (36%) people are either missing or
dead in the Cyclone out of 110,000 of total
population. According to 1981 figure
compiled by the Bangladesh Bureau of
Statistics total population of Kutubdia was
72,600 with equal proportion of men and
women. It is not clear what was the basis of
Mr. Ahmed’s statistics. Discussing with the
people around us we tried to make an
assessment asking them to tell about their
family and village. Perhaps the figure of the
population died or missing are not going to
be as high as it is estimated now for lack of
concrete information. Mr. Ahmed reported
that 99 percent of the houses and the
livestocks are completely destroyed. The
embankment is completely damaged Fifty
percent of the households lost their
utensils. These were quite obvious. We
walked and travelled around; wherever we
went, we found demolition of 100% thatched
houses, even some buildings.
Till then he had received 50 metric tons
of rice. EDM is planning to distribute
terpaulines as a temporary sheds. Mr.
Shahabuddin thinks it is difficult to use
them since the minimum speed of
the wind of the island is 25 miles
per hour, it easily accelerates to
50 miles in odd weather.
As an administrator he had already
developed a plan and structure to meet the
massive misery of his area. Apart from the
distribution of the food he insisted that the
priority should be given to pump out the
stagnant polluted water as early as
possible. The next priority is medical team
and medicine.
While we were discussing with Mr.
Shahabuddin, Mr. Khondoker Shahidul
Alam, (presently Deputy Secretary of
Commerce) newly apponted relief
co-ordinator for Kutubdia arrived by
Helicopter. He was a District Commissioner
Sunday Express 12
for Noakhali from 87 to 90. Shahabuddin did
not know about the new appointment and
seemed quite puzzled. The decision to
bureaucratize the relief operation is not a
good idea at all The administration should
encourage all
local initiative. The
bureacratic conflict may jeopardize the
already channeled steps of operation
undertaken by UNO.
Suddenly a staff of Mr.Shahabuddin told
him that one Major was calling him
downstair Shahullah as a UNO felt
emberassed before us because the military
officer should rather come to him if he
required anything. He told the staff, "tell him
to come here". The conflict between the
army and the UNO was obvious.
The young major entered the room with
his red face. He demanded that he
immediately needs three bamboos or long
stands and three pieces of colored cloth.
The air force is going to airdrop food. These
flag poles will be used for identification
above from the sky.
The way he was all excited and wanted
every one to be on their toe gave a feeling
that the Air Force is going to airdrop food for
a longer period of time I asked him for
clarification and learnt that the air drop was
only for today. I was surprised why he could
not organise three bamboos and three
pieces of cloth.
I asked Shahabuddin where he exactly
wants us to work For proper co-ordination
of the relief work he should be clear who is
doing what in which area. He suggested that
we should work in Ali Akbar Dail, specially in
the area of Khudiar Tek, because it is worse
affected. We told him that depending on our
resources we want to work in two to three
unions and co-operate and co-ordinate with
others who would be working in the same
and other areas. We also met Mr. Faridul
Islam, a lawyer by profession and the
present chairman of Kutubdia upazilla. He
also emphasised immediate provision of
food, pumps and shelters for the surviving
people. Mr. Faridul Islam and Mr
Shahabuddin Ahmed insisted that we must
arrange pumps to pumpout saline water from
ponds and install a good number of hand
operated deep and shallow tubewells
When we went out of the UNO office we
saw whole place had been turned into a
battle ground. The soldiers are ©penning
each of the packets of the Norwegian
biscuits and distnbuting two bars to each
But the ration was very limited. The deprived
crowd were angry.
While I was discussing with the local
people about the availability of necessary
commodities they complained about
quite
a
high
price
for
many
essential
items.
Akkas
bought
100gm of wire to rebuild his house.
He paid 10 taka for it while it was
only 1.50 to .2 taka before the
cyclone. Many people told that
Shakerullah,
Chairman
of
Boroghope Union was not allowing
any one to bring any materials to
sell in Kutubdia. He is the most
powerful trawler owner of the area.
As a consequence he enjoys
monopoly over the movement of
commopdities and trade in the
island. Shakerullah was present when we
were talking with the UNO.
From Kutubdia we went to Mongnama
There were dead bodies lying all over the
places here as well. Near the embankment,
half a kilometer far from the water we met
Moulavi Zahurul Islam, Imam of the Zame
Masjid (mosque) of Sharatguna. He with
three other persons was pulling a dead cow
by a rope to the river. He wanted to remove
the bodies at least from mam walking strip to
the ghat.
Islam had lost 21 members of his family,
he was the only surviver I explained him that
the body should be buried for health
reasons. If he pushed the body back
to ocean it will float back again to
Mongnama
or
to
other
banks
causing health hazards for others.
Despite his sad and emotionless
face he listened to what I said. He
was concerned for those who are
still alive.
Suddenly I noticed that he is carrying in
his hand a jute bag which GK had been using
for relief For environmental reason we are
trying our best to avoid the plastic bags I
asked him from where he received the relief.
It was army, he replied, which was quite
surprising for me. I reached inside his bag
and
found
the
slip
that
says
"Gonoshasthaya Sheba" (
means
Gonoshyasthaya Service). He also said that
t
the relief was given to him with the promise
that he will help to bury the dead bodies and
carcasses for his own good. I was sure that
GK relief team was operating near by.
Soon we met two soldiers who were trying
to convince a group of people to bury the
dead bodies and animal debns We asked
them who was distributing the relief in the
area. They replied that GK relief team was
here and they were helping them in
distribution, because local Union and
Chairman and members wanted to get the
relief mostly for their favourite few This is
not a new information anyway.
The soldiers also reported that there was
airdrop of food in the area However, they
complained that one bag fell in the water and
another one on the piles of dead bodies and
carcasses. People were so hungry that they
recovered the bag from the piles of
decomposed bodies. The bag in the water
could not be recovered.
We returned to Cox's Bazar around 5 in
the evening. Shafi and Shiraz had also
returned from Chokoria. We sat with the
Abhigyan group and explained the need for
community participation to face a disaster
of such a huge magnitude They agreed to
set up a roti production centre to reach a
capacity of at least 20.000 a day. We were
also informed that despite the damage
caused to trawlers and the boats
transporting rotis to Kutubdia or nearer
places is feasible. The bakery was not
available even if we pay a better price to
rent But more exploration was necessary.
We went back to Red Crescent Office to
finalize our immediate plan after
consultation with Sharif. I decided
discussing with Farhad, Shafi and Shiraz
that Gonoshasthaya should run its relief
operation in Cox's Bazar and Kutubdia. For
the time being the roti from Cox's Bazar will
be transported to Kutubdia until we can set
up a centre there. The medical team will
also be working in these places. GK will also
co-ordinate with the UBINIG relief activity at
Badarkhali in their project area If resources
are available UBINIG may create condition
for Gonoshasthaya Kendra for a larger
operation in Badarkhali-Mongnama area.
We went back to Chittagong at night
Next day Shafi and Shiraz went back to
Cox's Bazar to organize the roti production
centre.
PRACTICAL
CONCLUSIONS
d. Task of the medical team
l of I
S
I
ed. I
W
b Food pack and Roti production
1. Though the initial programme was for 4
weeks feeding; from our intensive visit of the
island, it became imperative that we must
continue modified free rationing in the form of
family pack for 2 months ( May & June)
Second help with specified quantity of wheat
flour would help maintaining minimum
nutrition.
2. Distribution of food bags containing
rice potatoes and pulses will continue in
Chokoria, Cox’s Bazar and Kutubdia We are
providing 6Kg rice. 3 Kg potatoes. 1 kg lentil
(pulse), some onions and chilli in a family
pack. Family pack ensures better
distribution. Besides family pack of rice,
potato and pulse, we distribute Pushti
(nutritious) biscuits - 2 biscuits provide 500
calone for children.
3. Roti production can be immediately
started in Cox's Bazar. Part of it will be
distributed around Cox's Bazar area but in
the beginning a major portion will be
distributed in Kutubdia.
.Housing must be treated as a relief rather
than as rehabilitation only.
1. It is often assumed that housing comes
under the rehabilitation programme and not
as a component of emergency relief But
information shows that people are not only
hungry, they are living under the open sky
without any shelter. Something must be done
immediately.
2. The cost of repairing a house may
exceed Tk. 2000/= per family.
a, Transportation of immediate relief
material
.
•
I
is at allJ
materials will be difficult but not
impossible as is generally assumed The
distribution of GK relief in Mongnama Union
clearly shows we can operate fairly well by
land in Chokona.
2 Kutubdia can be approached from
Cox's Bazar using trawlers, fishing boats or
large carrier vessel for immediate operation.
It is quite possible set up a relief centre in
Kutubdia.
*3 Relief activities for Cox's Bazar and
Moheshkhali can be operated from Cox's
Bazar
4. The donors should realize that a
significant portion of the relief fund will have
to be spent for transportation.
-
1. Despite the severe disruption of the
communication remotest areas were
accessible. Transportation of relief
HEALTH LuV Main# 1 Block
1. The burial of the dead bodies and the
caracasses should be the primary concern
of the medical team
2. In many places we found dead bodies
could not be buried because a shovel was
not available Medical team must carry
shovel with them. GK team always carry
shovel and few other similar instruments In a
post-disaster situation a shovel must be
considered as an essential device of
preventive health care.
3. To pump out the stagnant and polluted
water at least 50 pumps will have to be sent
to the area. Once the polluted water is
drained out the ponds will retain the sweet
water from the rain
e Drinking Water
1. Most of the areas will need deep
tubewell. With support from Public Health
department of GOB, GK intends to provide
deep tubewells. It may be costly but it is
imperative.
2 For necessary arrangement we had met
there Mr. Kaderuzzaman, with the
Superintendent Engineer of the Public
Health Engineering, who travelled from
Dhaka to inspect situation of drinking water
and sanitation.
f. Monitonng and Reporting
1. For efficiency in operation monitoring
and reporting is extremely necessary. Given
the experience UBINiG has in this field they
will be entrusted to collect necessary data
from the field to help the GK team to properly
identify the right beneficiaries.
2. UBINIG will also provide a midterm
report before providing the final report of
relief operation.
3. A joint GK-UBINIG team will be working
for a quick survey primarily to identify the
households to receive housing relief and
families who will require long time relief. The
survey will be the prelimmery basis to plan
and concretize the post-relief rehabilitattion
programme. A one-day training and
orientation will be required was conducted by
UBINIG.
Dr. Zafrullah Chowdhury is a prominant
leader at the NGO level. After the cyclone
he had been to some of the worst hit areas.
Sunday Express brings readers an
abridged version of the essay he wrote on
his return to the capital. The views
expressed by Dr. Chowdhury are of his own
and not necessarily shared by the Sunday
Express Editorial Board.
Sunday Express 13
Inadequate relief good
The government version is that relief is enough
and reaching the affected people. Is it so? Reports
however speak quite different things.
Till the writing of this report the
scarcity of life saving and essential
materials in the cyclone-hit areas,
according to different sources, has
become acute. Most of the
airdroppings are getting wasted
after falling into water. Rice, wheat
are of no use to those who neither
have utensils nor firewood to cook
them. Dressing materials like sari,
lungi are not priorities now. What
they need most of all now is
drinking water. The attempts at
private or non-government levels
to make up for the pathetic failure
of the government to tackle the
post-cyclone situation have not
met with success because of the
failure of the communication
system. Specially/ it has not yet
been possible to reach the islands
because of the rough sea and the
strong wind blowing at 70/75
diarrhoea and from the want of
relief material following the great
cyclone in 1970. Diarrhoea has
already
broken
out as an
epidemic. A field worker of an
NGO, Babul Chowdhury on his
return from Sandwip said, "Loose
motion started in some of them
while they were talking with us."
On returning Dhaka on May 8, he
said, 'Four days after the disaster
16 sacks of chira (beaten rice)
at
Sandwip.
were
dropped
Elsewhere there was no relief
materials’.
On
May
6,
a
government and two private
vessels reached the shore braving
inclement weather and rough sea.
But how far they progressed it was
not known. Relief materials have
reached in plenty at Banshkhali
because
the
communication
system is alright there.
Rice
Wheat
Biscuit
Sari
Lungi
4,700 mt
21,050 mt
600 cartons
5,000
5,000
2,000 tin
pieces
pieces/
km/ph. Helicopter is the only
means. But they are unavoidable
for that purpose.
Although the government is
trying to restrict the figure of
deaths within lakh the Leader of
the Opposition has claimed it to be
more than five lakhs. Many more
are almost certain to die from
diarrhoea, lack of food and water
and medicare. Mentionably, more
than one lakh people died in
According
to
government
source, four deputy secretaries
and eight assistant secretaries
have been drafted in the relief cell
at Airport, President’s Secretariat,
and Central Relief Control Room.
The government relief
fund is
totally empty now. Till the budget
for the new year is announced
there will be no change in the
situation. What has been spent so
on, the government level far have
Sunday Express 14
*
come from prime ministers’ relief
fund. The fund has been drawn
from the finance department
through special allotment. The
relief fund of the deposed
president Ershad has now been
changed into Prime Minister
Khaleda Zia’s fund. The break-up
of dispatched government relief
materials from April 29 to May 6 in
the affected areas Chittagong,
Cox’s Bazar, Noakhali, Feni,
Laxmipur,
Bhola,
Patuakhali,
Bagerhat,
Barguna,
Barisal,
Satkhira, Khulna is given below:
Comparatively Chittagong and
Cox’s Bazar got more relief
materials than other places. In
Chittagong 300 metric tonnes of
rice, 100 mt of wheat, 400 pieces
of sari, at Cox’s Bazar 450 mt of
rice, 200 mt of wheat, 500 pieces
of sari were distributed. Apart from
these only 5,000 jerry cans of
water were given. Taka one crore
was given to different district
administrators for cash distribution
and another 50 lakh was given to
buy relief materials for the afflicted
people. Every year the bulk of the
government relief fund is spent on
the
renovation
of
different
institution or historical places.
Although natural calamities are a
yearly phenomenon here, the
government relief fund is like a
drop of water in a desert. At
present at least Taka 10 crore is
needed on emergency basis for
relief operations. Also manpower is
needed to reach the relief
materials to the afflicted people.
The government performance so
far has been very disappointing.
-Shehabuddin Kisslu
i-r*
I
:
■
<w««!
WAVE OF DEATH
" This is not a time to be over critical, it is
a time to pull together...... "
The cyclone struck Bangladesh on
my birthday so it is unlikely that I will
ever forget this one. In fact as I write
this in Dhaka on 9th May the wind is
howling outside and the driving rain has
forced its way in to the house. I am
lucky to have one I
Half my life has been spent in the
Indian Sub-continent and I have been
personally involved in many disaster
situations starting with the aftermath of
the Bihar (India) Famine in 1966/67.
After that the Bangladesh Refugee
Relief Programme in India in 1971,
drought and floods in Western India in
1972, an earthquake in northern India
in 1975, and more recently the floods in
Bangladesh in 1987 and 1988.
The lessons I have learnt have been
many. One of the most important is to
have respect for indigenous and local
wisdom which is something that most
,,foreign,, experts totally disregard.
They believe that they are the experts.
I disagree. Local people often have a
sensible solution to most problems
however difficult they may be. In
Bangladesh, for instance, local people
are
the experts as far as
re-afforestation is concerned but rarely
are their voices heard. Even if they are
illiterate, that does not mean they are
uneducated. They know the right
mixture of tree species that should be
grown in their local soil. No foreign
expertise can improve on this.
• And in the floods of 1988 or at the
time of the 29th April tidal surge what
did local wisdom organize? Banana
trees saved many an animal by being
tied on either side of the animal to
make them buoyant; handpumps were
unbolted from tubewells and thick long
bamboos were jammed in the pipes to
prevent sea water from ruining the
drinking water supply. Children were
tied to upper branches of trees and
some survived; NGO development
workers on Sandwip tied themselves
together with ropes and tied the ropes
to their project office building and
managed to ride out the fury of the
cyclone so successfully, in fact, that
they were able to go out with the same
ropes and rescue people in the dark of
Julian Francis
the night. They are the experts and
they are right here. Foreigners with their
often untried disaster-preparedness
plans may have worked out theories in
some air-conditioned room but they do
not have the essential practical
experience.
SPARRSO
and
other
meteorologists gave all the
right information and many
people must surely survived
because of their warnings. The
question the weathermen and
others must have been asking
is why the Air Force and the
Navy were not able to take
some action to prevent the
heavy damage caused to planes
and ships all of which , would
have been pressed into service
now?
There may be many other questions
and criticisms. It is easy to criticise the
Government and the official machinery.
It is often very convenient to do so.
However, based on my past
experience, I wonder how many of
us have spared a thought for
the many Government and local
officials posted and living in
the devastated areas. They
may have lost members of their
own families. They, at least for
a few days, will have been in a
state of shock just like many
others. This one of the human
reasons
that
may
have
delayed a quick response.
This is not a time to be over critical,
it is a time to pull together and help
keep people alive bearing in mind that
the monsoon is round the corner and
the next few months will be very
difficult. As far as the NGOs are
concerned it is clear that the larger
ones, particularly those with ongoing
development projects and staff in the
affected areas, moved swiftly and
according to their own emergency
plans. The large NGOs like BRAG,
PROSHIKA, GK, CARITAS, CCDB,
CARE, RDRS,OXFAM were able to
deploy large numbers of staff and
materials quickly. Others such as
CONCERN and SCF(UK) who have
highly skilled staff experienced in
disaster work were able to move
quickly and have an immediate impact
in
conjunction
with
other
organizations more locally based.
However, coordination of NGOs at
any time is always a headache
because all of us want to do our own
thing and keep our independence and
we want our independence to be
visible so that the donors can identify
us. Many smaller NGOs, not based in
the disaster area, have, quite
naturally, wanted to rush with
personnel and cash. It would be more
useful if these NGOs linked up with
the bigger ones to have a more
meaningful impact. Now that ADAB
has an office in Chittagong and Cox's
Bazar, it is hoped that such
arrangements would be possible. All
resources
available-cash,
appropriate materials, transport etc.are limited and must be used
judiciously and efficiently. This needs
strong and diplomatic coordination at
all levels but through all the work that
is done a lot of attention must be paid
to the felt needs of the affected
communities and to local wisdom.
Julian Francis works for the
Canadian International Development
Organisation, CUSO and has been
based in Dhaka since 1985.
• V
Sunday Express 15
■ ;*_-
IS
11
... <71__.W-~~
_ _____
Reconstruction of
Chittagong Port cannot
wait
The Chittagong Port is the country’s principal port, which—on an annual
basis—handles nearly three quarters of its foreign trade. The April 29
cyclone has rendered the heart of the country’s foreign trade totally
inopetative. Our Financial Analyst analyses the situation and suggests
remedies:
888838$
The damages caused by the
29-30
April
cyclone
and
accompanying tidal bore are still to
be
fully
ascertained.
The
preliminary assessments already
indicate that in terms of the trail of
destruction it has left behind-this
cyclone is one of the severest
calamities faced by any nation in
recorded history. Why should this
over-populated and impoverished
land
where
people
are
continuously struggling to eke out
a living should face on a regular
basis such wrath of nature? It is a
question that is reverberating in
the minds of people across the
world. But, nature does not have to
answer this question. Perhaps it is
the mankind that bears the
responsibility of coming up with an
answer. It is the mankind which
has through ages abused the
nature--it is human greed that
causes the ocean to rise in anger
and the wind to blow in fury.
Geographically
small
and
economically
insignificant,
Bangladesh just happens to be in
the longitudinal and. latitudinal
coordinates where the wrath of
nature slighted by humans assume
demonic proportions.
Sunday Express 16
Now,
when
a
stunned
government-and
a
nation-is
starting to pick up the pieces and
getting on the long and uphill
journey towards restoration of
normalcy, the cyclone’s trail of
devastation is slowly, but surely,
assuming
another
dimension
which will be felt by the economy
of Bangladesh within a very short
time. This devastation will not be
accompanied with the crashing
sound of a cyclone but will spread
with the quite stealth of a
malignant cancer-with a crippled
Chittagong Port as the point of
origin.
z
The Chittagong Port is the
country’s principal port which, on
an annual basis, handles nearly
three-quarters of its foreign trade.
In the six-month period ending in
December 1990, the Chittagong
Port handled 3.4 million tons of
import cargo and 575,000 tons of
export cargo. The port has 19
jetties for berthing of ocean-going
vessels of which 15 are permanent
concrete jetties, two are pontoon
jetties, one is a timber-jetty and
another one is a light concrete
jetty. Two of the jetties are
multipurpose jetties used for
container handling. In addition, the
port has eight mooring berths, one
lighterage jetty and four public
sector jetties.
Between the port and the
confluence of Karnaphuli with the
Bay of Bengal there is an
approach channel of about 16
kilometres while the port jetties are
designed
to accommodate
vessels of draft upto 9.14 metres,
the limiting factor for permissible
vessel draft is the depth of water of
the ‘'Outer'', "Inner41 and "Gupta"
Bars on the approach channel.
The port authority has very little
dredging capacity which is less
than enough for maintenance
dredging. ’Karnaphuli’ which is a I
375 cubic meter capacity dredger
was procured in 1954 and has long
outlined its economic life. The only
other dredger that the port
authority owns is 'Al- Amanat'
which has a hopper capacity of
1150 cubic meters. As a result of
limited
dredging
capacity
Chittagong Port has a normal draft
limit of 8.5 meters.
This cyclone has been specially
cruel to Chittagong Port and it is
not going to be a ’normal time’ for
the port for a long time- how long
depends on a number of critical
factors. Most of the mobile
gantries
have
been
made
inoperative by the cyclone and
storage sheds damaged. Fifteen
ships have sunk in the approach
which
will
make
channel
navigation along the channel
hazardous.
extremely
Furthermore, silt and debris have
raised the channel bed.
Given
the
economy’s
overwhelming dependence on
imports, the Chittagong Port can
be compared to the heart of a
human. It it does not function well
and imports and exports are
restricted,
economic
activities
throughout the country will a suffer
setback.
The
port’s
serious
reduced operational capacity is
already a matter of immediate
concern as it is linked with the
inflow of foodgrains into the
country. The government has a
800,000 ton foodgrain stock which
is being used up very quickly to
meet food required by the people
in the cyclone affected areas.
Given the foodcrop loss caused by
the cyclone there is little prospect
that the draw-down of government
stock
can
be
foodgrains
from
local
replenished
procurement. While Bangladesh
for
significantly
will
qualify
enhanced levels of food aid from
donors, the country’s major port
Sunday Express 17
does
not
have
sufficient
operational capacity at present to
handle
the
incoming
food
shipments. According to a report,
two ships carrying foodgrain from
Australia are already waiting in the
outer anchorage while the port
authority is working hard to restore
as much operational capability as
it can.
The port authority and the
government have already done a
commendable job in making the
port operational-albeit to a limited
extent. Power systems have been
repaired and the mobile gantries
are now operational. The points
where
the
15
ships
have
submerged have been charted and
the approach channel has been
made operational. The port,
however, can only work the during
daytime and take in vessels with
upto 7.5 meter draft.
There is a limit to which traffic
can
be diverted
from the
Chittagong to the Chalna Port.
Thus, unless immediate steps are
taken
to
increase
channel
navigability through dredging and
salvage
operations
the economy will
experience
severe
supply
shortages.
Such steps should
include
immediate
repair
and
rehabilitation of the
floating crane which
submerged partially
after the striking of
Karnaphuli Bridge. In
case of rehabilitation
and reconstruction of
Chittagong Port, the immediate
should mean ’now’ and the
government should not hesitate
using its own cash resources for
this purpose since case getting
financial assistance from donors
overriding
take
time.
The
consideration in this case should
Given the economy’s
overwhelming dependence
on imports, the Chittagong
Port can be compared to
the heart of a human. It it
does not function well and
imports and exports are
restricted, economic
activities throughout the
country will a suffer
serious setback. The port’s
reduced operational
capacity is already a
matter of immediate
concern as it is linked with
the inflow of foodgrains
into the country.
be that if Chittagong Port cannot
be made fully operational within
the shortest possible time, the
country's capability to import
much
needed
relief
materials-including
food
and
medicine and building materials as
well as critical raw materials e.g.,
petroleum-will be constrained
which will bear high cost, perhaps
even in terms of human lives. That
is the short term dimension of the
problem. In the medium to long
term framework Bangladesh will
have to think of starting a cyclone
rehabilitation and reconstruction
programme. The inputs for this
programme
e.g.,
cement,
machinery, etc., will have to be
imported and transported to the
cyclone affected areas before the
onset of the next monsoon.
Otherwise the duration of the
misery of the people in the coastal
belt of Bangladesh will be unduly
long.
—Express Report
Catastrophe as Pornogrpahy
and Public Relations
Wilma Van Berkel
Wilma Van Berkel is a Canadian freelance management consultant.
For the past two years she has been on a sabbatical
journey—largely across Asia. Her incisive comment on journalism
demands attention. WVB writes for Sunday Express.
Since coming to Bangladesh, I have been taken
aback by the newspaper "journalism" in this country.
The obsession with printing photographs of
corpses--be they from traffic accidents, industrial fires
or natural catastrophe--and the blatant tendency of
the newspapers to play a public relations role for
selected groups and individuals seem to have no
limits whatsoever. For example, listing of all of the
participants at a meeting is done without mentioning
what was said.
The recent tragic cyclone has raised these
tendencies to a still newer, and in my view,
completely irresponsible level which must be
acknowledged and challenged.
Pornography
Last week, I was appalled and horrified when i
picked up the Saturday, May 4 edition of 'The Daily
Ittefaq" to see two extremely chilling and graphic
photographs of corpses on the front cover. I tossed it
down. Picking up some of the other papers, I noticed
that they were only slightly less obscene. I forced
myself to look at the Ittefaq again and I felt my anger
growing.
Let me describe the pictures for those who missed
them. One is the picture of a dead woman with a baby
hanging from her abdomen. Both corpses are swollen
and disfigured. The exact centre and focus of the
photograph is one exposed and disfigured breast of
Sunday Express 18
the woman with the nipple swollen and erect. The
other is of a completely naked, swollen female corpse
hanging from a tree branch with a man in the corner
of the frame looking up at her.
What can possibly be the purpose of printing such
pictures? It might be argued that they highlight the
tragedy of the people who were caught and perished
in the cyclone. For me, this does not capture the
tragedy of their suffering. Rather, it is the degradation
of a corpse which should be buried, not
photographed. Although those of us who did not
experience this cyclone firsthand have some difficulty
comprehending the scale of this disaster-- such
photos do not help. They numb us further.
I contend that these photographs h^ve only one
purpose-to capitalize on the tragedy of people in
order to sell newspapers. Because unfortunately,
some people are drawn to .such things. But
responsible journalists rise above such temptation.
Such photos which degrade the victims are a
disgrace. It is not journalism. It is obscene
pornography, and the Ittefaq, and others who follow
this path, are functioning as pornographers!
Public Relations
Throughout the cyclone and its aftermath, .the
tendency towards journalism as public relations
continues. When there is a section on relief it reads
like an organizational directory-such and such a
Both corpses are swollen and
disfigured. The exact centre and
focus of the photograph is one
exposed and disfigured breast of
the woman with the nipple swollen
and erect. The other is of a
completely naked, swollen female
corpse hanging from a tree branch
with a man in the corner of the
frame looking up at her.
\
\
\
I
\
What can possibly be the purpose
of printing such pictures? It might
be argued that they highlight the
tragedy of the people who were
caught and perished in the cyclone.
For me, this does not capture the
tragedy of their suffering. Rather,
it is the degradation of a corpse
which should be buried, not
photographed. Although those of
us who did not experience this
cyclone firsthand have some
difficulty comprehending the scale
of this disaster— such photos do
not help. They numb us further.
\
;
j
>
s
j
?
?
;
group gave relief to this and that fund. Pieces about
international and non-governmental organizations are
the same- often not listing the area where relief is
going. The most important part of the articles clearly
are the headings or sub- headings listing the donors.
Or there are articles about relief coordination
meetings which use this "so and so spoke" or "so and
so reported" style without providing the salient and
important points.
The need for concrete
information
Too much valuable text in newspapers is being
spent on public relations for certain individuals,
groups and agencies. Too much valuable space is
being used on appalling pictures which numb or
unfortunately, titillate the viewers.
In this time of crisis in Bangladesh, what is needed
most is solid information-where is the damage? What
are transport conditions? What materials and help are
needed? What are the specific relief operations?
Where is information being gathered? Who is doing
what and who is not doing what they should be
doing? This is concrete information that will help with
the relief and rehabilitation works which are going on
at this moment. People need to be mobilized to
concrete action!
In order that I cannot rightly be accused of merely
complaining about the situation and not offering any
alternatives, here are two specific suggestions:
Photographs about the tragedy could show the
physical devastation and could highlight the personal
situation of the survivors but they could also highlight
the relief and rehabilitation work which is going on.
Not the Armed Forces Officer ceremoniously handing
over a sack of wheat, not another picture of P.M.
Khaleda Zia looking distressed but photos of
individual initiative, courage and resourcefulness the
affected people attempting to put their lives back
together, the spontaneous generosity of the
unaffected people in gathering food, clothing and
medicines which is going on all around. Photos which
inspire people to join in the effort to provide relief on
the ground.
It would be utopian, I suppose, to suggest that all
of the public relations stop, as perhaps some groups
require mention in the newspaper as a payment for
their generosity. But I would suggest a major addition
to each and every paper. Cries for coordination to the
relief have been coming from every quarter and
various groups from within government, in the private
sector and in the NGO sector are not very effectively
trying to fill this role. I contend that in such a situation
the newspapers have a valuable role to play in helping
to& fill this gap.
All newsppaer reporters, correspondents etc who
report from various areas must be instructed to find
out as much concrete information as possible about
aspects which will assist the relief and rehabilitation.
Answers to some of the questions which are listed
above-what is the extent of the damage in an area?
Sunday Express 19
how many survivors are there and what is the extent unite with their efforts to recover from natural
of their need? what relief is on its way to a particular catastrophe which human effort can overcome.
area? what groups are assisting?-this information
should be collated and presented in a manner which
will assist with the relief work. Listed perphas by
upazila so that it
Recently
will become clear
the Voluntary
which areas are |
Health
being served and |
Services
which are not.
Photographs about the tragedy could show the
of
Society
:•:
physical devastation and could highlight the
Newspapers
x Dhaka
has
should open their
personal, situation of the survivors but they
printed a very
phone lines and
poster.
could also highlight the relief and rehabilitation
large
encourage
The major part '
work
which
is
going
on.
Not
the
Armed
Forces
and
groups
of the poster
Officer
ceremoniously
handing
over
a
sack
of
$
to
individuals
covered
was
wheat, not another picture of P.M. Khaleda Zia
report
concrete
by the two
*
looking distressed but photos of individual
information they
horrifying
have to any of the
initiative) courage and resourcefulness the
of
pictures
papers and this
affected people attempting to put their lives
disfigured and
information
naked corpses
back
together) the spontaneous generosity of the
should be shared
of women from
unaffected
people
in
gathering
food,
clothing
between
all
the
May 4,
and medicines which is going on all around.
papers. Perhaps
1991 edition of
Photos which inspire people to join in the effort
a team of writers,
"Daily Ittefaq"
one from each
to provide relief on the ground.
newspaper.
S
paper could do
The
only
the •
work
s printed
together.
I
information of
imagine a situation where, whenever such a disaster the poster were the name, address and phone
occurs, each of the daily Bengali and English papers number of the VHSS.
will have an entire page--or more if needed-devoted
Appalled, I called up VHSS and spoke to a Doctor
to this type of solid, concrete and absolutely
Shabnam. What is the purpose of this poster? Are
necessary • information. As well, free classified
advertisements from people offering transport or you asking for something? No, No was the response.
goods, highlights of urgent requests in different areas It is only to publicize this disaster and to encourage
people to help. Why did you choose these pictures?
and pieces celebrating the small victories.
They were chosen at random. They are not our .
. One might ask if this is really the role of photographs, we got them out of the newspaper.
newspapers-or the role of other groups or
I then explained my perception of these pictures
government? Perhaps in time-but it is an important
gap now and the daily newspapers are already in the as pornographic and that I was shocked and appalled
business of collecting and reporting information and to see an organization highlight them in this way. If an
getting this out in a short space of time to the widest organization is going to spend money on a poster at
possible number of people. It is a natural extension of this time, I said, better they printed - one listing
materials required and groups to contact. I demanded
this role.
that the poster be withdrawn immediately.
Focussing on the dead is degrading and
Dr. Shabnam responded that they certainly did not
demoralizing. Focussing on the donors is public
relations. What is needed is a focus on the survivors think the pictures were pornographic and they were
and how all available resources can be mobilized to not chosen for this purpose but that she would
discuss the issue with her seniors. #
NGO as Pornographer
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Sunday Express 20
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___________
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-------------:;;—i_________ _________
■_________ _____________ _ _____________
Communications problem halts relief
operation
Those who have survived the battering of the cyclone and tidal surge are
experiencing a death-in-life situation in the affected areas. Without food and drinking
water under the open sky. Relief operations of the government has left a lot to be
desired. Specially a remark by the communications minister Col (Retd) Oli Ahmed
has raised question in the minds of people. Ahmed said, "Nothing has happened at
Sandwip. There is no need for relief in that place." Those engaged in the relief
operations can testify to this appalling situation. Various NGOs and voluntary
organisations are continuing their relief operations in full swing in the affected
areas. Khushi Kabir is the managing director of one such NGO named ’Nijera Kori’.
On May 3, she went to Chittagong to stand by the helpless people. She could not go
beyond the perimeter of Chittagong for some unavoidable reasons. Back in the
capital, she talks to Sunday Express:
®
Tell us of your experiences in the affected areas.
I reached Chittagong on May 3. Our workers had
already been working there. Chittagong looked like a
haunted city. No electricity. Corpses and the carrion
everywhere. The air was filled with stench. No food, no
potable water. People stopped our car and asked for food.
People irrespective of their class, status have been levelled
by the storm. This is what I saw in Chittagong city. We
could not elsewhere for the disruption of communication
system. The intensity of this cyclone was greater than that
of 1970. You simply cannot imagine it from here.
What measures have you seen on the
government level?
I did not see anything in the five days I stayed there.
However a local ADM helped me a lot in the relief
operations.
Do you t hink that relief operations now going
on is enough?
I do not know exactly what is happening now. But
things, as I have heard, have improved considerably. I
gained bitter experiences during my sojourn there. Apart
from, the activists of the All Party Students Unity, I saw no
<> one there. No government activities. Many people asked
me why the relief and rehabilitation work was not started
right away. No attempt was made to remove the dead
bodies. "As the head of the government the president
should have been there before anyone else. Whether they
were being intentionally neglected; I could not answer their
queries. One of my colleagues from Sandwip told me that
the communications minister, Oli Ahmed said "Nothing
happened at Sandwip. You give your aid and relief
materials to us. We will make arrangements for proper
distribution".
According to them the Haramia field of Sandwip upazila
head quarters was high and dry enough for the landing of
helicopter. But the helicopter on April 30 circled over the
field but did not land. Hatiya is also severely affected. The
way they are dropping food stuffs from air is not serving the
purpose. Most of the food stuffs are landing in water.
Rather they should go among the afflicted and start
working.
The members of the armed forces were not very active
initially. The reason is not known to me. Things have
improved after high powered relief coordinator were sent to
the affected areas. It would have been better had they kept
all types of people in the relief committee-non-government
and private. People have raised questions over this.
However there is one bright sign. The government,
opposition and the student alliance have held meeting with
us. This is an encouraging sign for the new-found
democracy. ’
What steps according to you should be taken
to overcome the present crisis?
Well, it would have boosted the confidence of the
people of Chittagong if the city could be cleaned and some
drinking water be managed. The people in Chittagong are
very disappointed and confused. They have a feeling of
being neglected. They’ were not prepared for this. But I
think the following measures should be taken immediately.
* All concerned should be assembled to gear up the
relief operations.
* The helpless afflicted should be moved to safer
places. '
* Arrangements should be made to send the
volunteers in the affected areas.
* Instead of air-dropping the food stuffs people
should taken those themselves.
* Instead of china (beaten rice) and gur (molasses),
rice should be provided.
* People of importance should refrain from making
statements like Oli Ahmed so that volunteers can work
in full throttle.
♦ The corpses and carrion should be cleared up
immediately.©
Shehabuddin Kisslu
Sunday Express 21
The govt has admitted its failure
says an NGO official
Jeffreys. Pereira, executive director of’Caritas’, a leading NGO in the
country', had recently been to the cyclone affected areas. On his return he
talked to the Sunday Express correspondent on the relief operation of
government and private voluntary organization.
On the overall situation in the affected areas.
The present crisis is unprecedented. Normally
after a cyclone the weather becomes normal and the
relief operations can be started immediately after the
catastrophe. But this time the sea is yet very rough.
Strong wind is blowing accompained with heavy rain.
Relief work is severely hampered by these things.
Diarrhoea has already broken out and with the rainy
season in the offing. I am afraid things will soon go
out of control. Mere supply of food will not serve any
purpose. At the moment We are trying to implement
five things. First we have to deal with the problem of
drinking water. Water is being pumped out of the
ponds and I don’t think it is possible for us to carry
out the whole plan, still we are trying to pump one or
two ponds for each area. Water will be naturally
purified by June-July.
You need a crop after such calamities. Maize and
vegetables could be planted. But it is not possible for
the saline water poured all over the place by the tidal
surge. Cash for work will be a more effective measure
under the present circumstances. Because with food
for work programme.
You have a store of food in godowns and silos--a
very lengthy process. The government should take up
project of building dykes on priority basis. There is no
other way of checking the rush of saline water from
the sea.
The government has not taken up cash for
work programme...
Sunday Express 22
No. It has not but we
the NGOs have already
started it although the
possibility of success in
very slim.
Are you carrying out
survey on your own? -
Nothing in black and
white. We are trying to
make do with the reports of
our workers and their correspondences. It is not
always possible to go to the spot. More so when the
extent of damage is so vast and enormous. We have
made base camps in the affected areas. Workers
there will carry out a house to house survey. That is
how we are trying to do it.
On the bureaucratic snags and bottlenecks in
the distribution of relief materials by the
government?
The government has already admitted its failure in
this area. They made it clear that it is not possible for
them to rise to the occasion.
On the sort of relief work the affected areas need
most right now.
Firstly, dry food, something which you don't have
to cook can be distributed readily. There are some
foreign high protein biscuits, two or three of which is
enough to provide calories for a day. The local
biscuits Cookies, Bela will do also. In short you have
to give them cooked or readily edible food stuff. After
that comes the question of rehabilitation.
W® OF DEATI!
*4 »J,9
• • • • • • • • • • • ••*••• • • • • • •
It has been complained that the distribution of
relief materials is not going on properly. What is
the remedy?
It is happening because proper coordination has
not been established yet. Suppose at one place 10
NGOs are working and none elsewhere. We will
unitedly submit a plan to the government. Crop, cash
for work, having will be there. We will give emphasis
on the question of professional rehabilitation. .
(After this he took this correspondent in the
operation room to show their chart plan. That showed
the things below:)
Supply of potable water in cans, repairing or
pumping the ponds, dry food first aid antibiotic etc.
Diarrhoea at many places has broken in epidemic
form. We are trying to check it.
Also supply of clothing like sari, lungi must be
continued. Then housing. We are the only people
who have built cyclone shelter. We have made twelve
such shelters after the cyclone in '70. We have
undertaken the plan of installing another 50. Apart
from this we have a project of making tin-shed
houses which cannot be started before September
(He showed model of the tin shed house). By June
we have to give a ration card to every family. We also
9 9 9 9 •
• «F>*"*^** ’ • • • • •
—
have to ensure regular and weekly distribution. For
the first phase of the plan we have allocated 12.5
million dollar and another 50 million taka for the
second phase. Manpower is no problem at the
moment.
What else the NGOs can do?
JP: It will be a great help to the suffering millions if
we can accomplish the five point mentioned. We have
to carry out a study on the recurring trend of such
calamities. Asian Institute of Technology in
Bangladesh can do this and we will take this
responsibility but you must remember our ability is
limited. We have more contacts then government.
How far is the relief work pragmatic? Is it
sufficient?
I have been to different affected areas except
Sandwip and Hatiya. Our ship will start for these place
with relief goods on Monday or Tuesday. So far it has
been impossible to reach these places because of
inclement weather and rough sea. But one thing the
relief operation has to be continued for a long time.
How, this cyclone is going to tell on the
socio-economic condition of the country?
Had our’s been a developed country. I would
have said, we were finished. But this has become a
• regular phanomenon and time and
again we have shown some kind of
resilience and grit in overcoming
such crises. Salt plants for example
are finished. Many industries have
been destroyed. Saline barriers are
SUNDAY EXPRESS changes its address
totally damaged and cannot be built
again easily. All in all, I think the
cyclone will have a catastrophic
impact on the socio-economic
..
■
condition of the country.
CHANGE OF ADDRESS
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BillW
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1
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B
... *.-.s
•••:•.•:
...•>.••:••
M
OLD
18(b) Old,
9Ka(New)Mymensingh Road
Dhaka
•
....
new
50/F Inner Circular Road(3rd
Floor)Shantinagar, Dhaka__
_______ ■
-Monirul Islam Nipu
DEPARTMENT OF ENGLISH
UNIVERSITY OF DHAKA
conducts
SEIORT ■
COURSE
IN ENGLISH
a bO hour course open to outsiders
Sunday Express 23
Nepal is going democratic way.
But still the country is under the
monarchical shadow.
Nepal’s nascent democracy
faces a tough test on May 12 as
the Himalayan Kingdom goes to
polls, first of its kind in 32 years.
The polls are to complete the
process of a grand transition, from
an absolute morarchy to a
Westminister-type
parliamentary
democracy, which began last year
when a popular uprising forced the
all-powerful
monarch,
King
Birendra Bir Bikram Shah Dev, to
agree to reduce
himself only to a
constitutional
one.
In
1959,
under
King
Tribhuvan, the
only
previous
such poll was
held and Nepal
experienced a
brief spell of
democracy.
Hardly a year could be passed,
King Mahendra, Trbhuvan’s son
and
successor,
banned party politics
to
introduce
a
partyless system which
ensured his absolute
powers
in
administrating
the
affairs of the state.
King Birendra, son and
successor
of
Mahendra, preferred to
follow the footsteps of
his father rather than to
his grandfather.
Conceding to the
pressures from the
pro-democracy
activists who took to
the streets to oppose
his role as the absolute
Sunday Express 24
/
ruler, King Birendra had to give
consent to the formation of an
interim administration to guide the
nation through the process of
transition. A coalition of the Nepali
Congress
and
the
Nepal
Communist
Party-the
parties
instrumental to the pro-democracy
movement, the interim government
was sworn in April’1990 with two
prime responsibilities: 1) framing a
democratic constitution, and 2)
holding general elections within a
year. ..
Within six months or so, the
interim government, headed by
Congress leader Krishna Prasad
Bhattarai, presented the country
with a constitution that guarantees
multi-party
democracy,
fundamental human and civil
rights, and also reduces King’s
INTERNATIONAL
status to constitutional monarch
and vests sovereignty • in the
people. A successful holding of the
May 12 elections will complete the
Bhattarai administration’s job.
1345
candidates
in
205
constituencies will seek people’s
verdicts to form the new powerful
legislature styled as the House of
Representatives. Barring a very
few independents, all of them are
nominees of different political
parties and 10.7 million eligible
voters in a population of twenty
million are to exercise their right to
franchise.
The
11-member
interim
administration has . promised a
A free, fair and impartial election. A
National
Election
Observation
Committee
comprising
the
country’s prominent personlities
has been set up with • the
government’s approval. Observers
from 23 countries have already
arrived to oversee the polling. In
addition to 30,000 permanent
security force, 42,000 temporary
security personnel have been
recruited to be deployed at 14.000
f polling centres. The Election
Commission has formulated a
code of conduct which all parties
agreed to abide by.
Though there are reports of
sporadic
electoral
violence
throughout the country, mainly
due to the lack of democratic
4 tolerance among party workers
and activists who never had had
the opportunity to practise it, most
Nepalese are optimistic about fair
election.
Some
24
small
parties
registered with the EC, are
boycotting - the polls alleging
’irregularities by the government
and ruling parties. Many of these
parties are believed to be the
agents of such quarters who
oppose the
inauguration
of
democracy.
There
are
speculations that these paities,
who have no substantial popular
support,
might
attempt
to
destabilize and discredit the
democratic
system.
Another
reason being cited is that some of
the boycotting parties fear of being
trapped
in
a
constitutional
provision requiring parties to
secure at least three percent of the
total votes cast as a precondition
to get recognition as a national
party.
(
The centrist Nepali Congress,
which won a two-thirds majority in
the 1959 polls, hopes to repeat its
performance
32 ' years
ago.
Though opponents rule out such a
possibility, very few dispute about
its chances to emerge as the
single largest party. In such a
case, the Congress-Communist
coalition is likely to continue. The
leader of the Nepal Communist
Party or the United Marxists and
Leninists (UML)
has already
spoken of such an idea.
Political analysts in Nepal fear
that if any of the parties fails to win
an absolute majority, and a
coalition does not follow to ensure
stability, the King will have the
opportunity to reassert his role.
The King is still considered by the
majority of his subjects, 70 percent
of whom are illiterates, as the
symbol of unity. Many of them
even believe in the divinity of
Kingship. The King may take the
advantage of a hung parliament,
manipulating
the
people’s
ignorance.
The
country’s
progressive intellingentia foresees
such a situation. The leaders of the
two major political parties have
realised this and already urged the
conscious segment of the society
to keep guarding against any
conspiracy of what they call the
"revivalists". Successful holding of
elections and transfer of power to
the elected government will not
only institutionalise the new order,
\
The King is still
i
considered by the
| majority of his subjects,
j 70 percent of whom are
illiterates, as the symbol
of unity. Many of them
even believe in the
divinity of Kingship. The
King may take the
advantage of a hung
parliament,
i manipulating the people’s
ignorance. The country’s
progressive
intellingentia foresees
such
a
situation.
i
but also mark the world’s only
Hindu state’s stepping into modern
age.
— Toutlque Ini rose Khalidi
Sunday Express 25
NATIONAL
New
JP, the party Ershad floated
some years ago to prop up his
illegal regime, far from being
disintegrated still moves on.
Contrary to speculations, the
Jatiya Party (JP), the party of
deposed autocrat Ershad is not
going to be disintegrated in the
near future. The main problem of
the leaderless party is the
grouping among its stalwarts. With
Mizan
Chowdhury in jail and
Moazzem
reluctant
to
join
opposition
politics,
Moudud
Ahmed, acting chairman and
parliamentary party leader of the
JP, is emerging as the lone star in
the party. A firm believer in
individual image than party image,
Moudud has already cancelled any
possibility of staging movement in
next two years. In a recent meeting
of the JP at Tongi Hasanuddin
Sarkar said "In the event of
punishment of our leader Ershad,
we will go into the presidential
polls with present party chairman
Moudud
Ahmed."
Moudud’s
release from jail added a new
dimension to JP politics. He did
not go to Mizan Chowdhury’s
house, the make-shift office of the
party immediately after his release.
Interestingly, his first visit to that
place coincided with the arrest of
former acting chairman, Mizan
Chowdhury. Moudud, it is learnt,
was quite displeased with Mizan
because his wife Hasna Moudud
was insulted by some of Mizan’s
supporters.
Moudud
slowly
assumed control of the party after
Mizan’s arrest. Moudud seems to
have decided to proceed slowly.
Sunday Express 26
He has kept his options open for
joining the BNP, the party now in
power in a suitable time.
Among his possible rivals, Shah
Moazzem is now a changed man.
Like some of the so-called leftists
he is now more intent on sharing
power with the government than
opposing it. Known as the most
foul-mouthed politician, Moazzem
was earlier fed up with Mizan
Chowdhury. However Mizan never
disturbed him and Moazzem
formed a new committee with
people like Amina Bari whom
Ershad ousted from the party on
Kazi Zafar's advice. Holding
portfolios in seven of the nine
years of Ershad regime, Moazzem
no longer says, "I am honest"-an
assertion he made after his release
from jail where he was thrown into
on charges of misappropriation of
wheat.
Mizanur Rahman Chowdhury,
who last went to jail in 1966 is now
behind the bars in Jessore
because of his political genosity,
weakness and carelessness. Many
blame his political secretary
Sayeed Tareq for the downfall of
the veteran JP leader. Once a JSD
member, he got close to Mizan
Chowdhury at the time of
formation of Janadal. Recently he
was taken in the fold of the JP
although he did hardly any work
for the party. More recently, he
tried to incite the army by
spreading leaflets. But they were
seized before distribution. Wittingly
or unwittingly, he courted disaster
by associating himself with this
Interestingly, his first
visit to that place
coincided with the arrest
offormer acting
chairman, Mizan
j
Chowdhury. Moudud, it
is learnt, was quite
displeased with Mizan
because his wife Hasna
Moudud was insulted by
some of Mizan ’s
supporters. Moudud
slowly assumed control of
the party after Mizan’s ;
arrest. Moudud seems to
have decided to proceed ?
slowly. He has kept his
options open for joining
the BNP, the party now
in power in a suitable
time.
mysterious figure. Many secrets
about Ershad and the JP are
known to this person. It will not be
surprising if he tries to blackmail P
Ershad and others in the party.
Under
the
circumstances
Moudud Ahmed
looks most
fortified. He has already drawn
ex-BNP and NSF members around
him.
The
leader
of
the
parliamentary party of JP has
already established himself as the
only substitute to Ershad in the
absence of Mizan, Zafar and
Moazzem from the scene.
-Mahbub Chowdhury
THE LOST HORIZON
A part of Bangladesh in the geopolitics. This low terrain is a
south has perished. Like it did in venue of such visitations for
1970. But the similarity should end centuries and it is time that the
there at least on one vital count. In loose ends of the tangle were
the 20 years since, the world has sorted out. As long as the living
of people in the
come a long way so far as standard
technological
and
scientific disaster-prone areas remains so
advancement
is
concerned. low, they are expected to be the
Monitoring of weather by satellites most ill-prepared to face such
is almost precise today and this natural calamities. Some of the
hapless country can confidently
count on weather reports now
Nilratan Halder
received by the highly sensitive
equipment at its ground centres. islands and coastal areas are
The advance warning system simply uninhabitable and the
worked. But alas the warning is yet administration has hardly cared to
to be well in advance to help tell the people living there so. If
people to make it to a safer place that is not enough callousness, the
in time.
administration over the years has
That points to the fact that the been known to back out from the
people in the coastal belt, except projects it devised for itself to carry
perhaps at a few places, remained out in the areas in question.
as unready--and therefore at the
To raise the quality of lives and
mercy of nature’s one of the that too in areas coming under
fiercest forces--as ever. Ferrying frequent batterings by cyclonic
people out of the danger zones storms is to entertain an unrealistic
and on so short a notice is an
thought. But something practical
impracticable proposition. Does it can still be done. Considering the
mean that the tens of millions in massive pouring in of resources
the coastal areas should be left after each such disaster, the
exposed to elemental fruies? In the rationale for investment in normal
intervening
period
between time looks very strong. An
batterings by natural forces must investment of such a nature may
people and
the government
have double the benefits than the
assume a Buddhist resignation to
ones achieved in disaster time.
meet their fate with no glimmer of
The overriding need is to build up
hope?
some physical infrastructures of
Such a prospect is likelier than public uses. Apart from the
not. But still questions remain. And cyclone shelters, the schools,
the questions are rather more colleges, mosques, temples and
disturbing
than
intriguing. community
centres
can
be
Disturbing because it amounts to integrated into such centres. Not
facing an unpleasant truth. The only will they serve as the shelters
truth manifestly is tangled in the in emergency, but also provide the
national wrong
policies and necessary thrust to the much
priorities in relation to complicated needed area of education.
But again the scarce resource
will be referred to. And there
indeed the role of geopolitics
makes, albeit subtly, its presence
felt. There is no conclusive proof
that environmental degeneration
directly leads to this or that natural
calamity, but what is certain is that
they have over the decades heavily
contributed
to
ecological
instability. Release of chemical
effluences and experiment with
nuclear devices have made the
earth more convulsive than it had
been before. Add to this the
prompt reaction to Saddam’s
occupation of Kuwait. The Western
powers embarked on a crusade
against one man's army to save a
tiny Sheikhdom. That earned them
a few kudos. But look, the
engagement in the desert called
for millions of men and billions of
dollars in armament and many
other daily expenditures.
After two weeks, the few living
in the cyclone-hit areas hopelessly
wait for such a god-like rescuer.
But no luck this time. Only a
fraction of what perished in the •
sand could be enough to give
them a new lease of life. But the
civilised world knows its priority
better. This is no war, nor there is
oil here. So let the hapless men,
women and children suffer the
worst and the magnanimity of the
great powers take a monetary
leave. The people in the poor
countries are thus fated to
endlessly suffer. Could not it be
different had the nations posing to
be protectors of and/or saviours
the weak really been true to their
words?
Sunday Express 27
KaladarshPs column
|
’Aposh-hin — arrogance
game on the lakhs of
dead--
Fifteen million people have been affected by the April 29 elemental swoop of the
coastal belt. This is the official figure. Unofficially it is feared that as many as ten
lakh people might have perished on that doomsday night. That leaves us with 14
million people in dire straits. The task is now to ensure that not many of these
survivors die in consequence of the April 29 disaster.
•
•
•
How to ensure that? You want to help each of them with one chapati-ruti? You will
need 14 million of them requiring more than a million kilograms of wheat—that is
1000 tons of wheat. Want to help them with a light? You will need thirty lakh of
them. Where can you get that? The official figure for the houses completely
destroyed, although very much incomplete, is around seven lakh. Want to help
them with a bamboo each ? Very tough indeed. Food and water are recurring daily
needs. If this number of people have to be helped with that for any span of time—it
will take all power of the government.
Now how to reach them and see that these reach proper hands and before people
start dying? The support, if distributed through proper official procedure, will
reach people only after another million will have died. Government, or whoever
wants these people to live, will need at least 50,000 selfless dedicated relief workers
to reach the first essentials to the needy. Wherefrom will such people come?
Nothing on this scale will be realised. People will die uncared, unhelped. People
will live uncared, unhelped. And government will go on boasting about its
wonderful relief operation. But this shouldn’t have been so. The first
democratically elected government in 16years should have proved they are
different. The least they should have done is to show that they have comprehended
the size of the challenge and the nature of it— which goes far beyond saving the 14
million surviving souls. The challenge is to save the whole of the national economy
from an overall collapse.
*
The prospect of grappling the challenge as it should be is bleak indeed. There are
very many reasons for that. The overriding one is a new phenomenon—a
non-soldier, elected and female autocrat in the making.
Sunday Express 28
Kaladarshi’s column
overnment, till May 7, did
own up a 125,000-plus
figure for those killed in April 29’s
elemental strike on the eastern
G
She has done unfairly
for the body of the
nation. What about the
nation’s soul? Well, she
has taken care of that
too by welcoming the
chief of a state which
was responsible for
| killing—by shooting and
; bayonetting and burning
: and torturing—millions
\ of Bengalees in only nine
months. Have they
repented? Are they on
\ record to have accepted
that their 1971
; performance fell outside
of civilised behaviour?
\ All they have said to date
is that the bloody nine
months were a case of
|
misunderstanding
between brothers and
\ both sides were equally
|
to blame for it. You
| welcome him—and your
press goes very warm
and chummy and gives
him all space and
prominence in the
world—in order that he
can again throw the
| ’brother’ business on our
face and promise to do
all that in Pakistan's
power.
I
to
i
i
■
offshore region. This was arrived at
through official body-count. This is
going to radically rise when the
main hit areas in the three big
islands-Sandwip,
Hatya
and
Kutubdia-will be connected by
effective administrative machinery.
This figure does not include
those that have been washed away
to the sea. Which again can very
drastically change the. present.
And add to this the conjectural
figure of 100,000 fishermen being
lost. This is staggering. Please
divide the tally by the square
kilometres where more than a
hundred have died. You will,
Madam Prime Minister, arrive at a
figure that will mock at your
insistence that deaths have been
minimised by the government’s
early
warnings
and
other
preparations. This figure--and the
dead behind this—will, till your last
day in this world go on telling you
not only you have been foolish in
playing that ’aposh-hin’ arrogance
game on the lakhs of dead-you
have simply been mindless.
Exactly as you won your
election, you have won this time
also and are carrying the nation
with you. With your mindlessness.
The six million people in the capital
city go. about their usual daily
business--not one of them has
shed one little tear. How you have
succeeded to box in the nation’s
mind-to the size and nature
congenial to your and your party’s
limited capacities in the matter of
having a mind, an intellect,
something
transcending
immediate personal gain and
personal prejudices.
The dead of April 29 are gone
and no one would-blame any of
that on you. More three lakh was
saved by the less than 300
hundred cyclone shelters and
Mujib-Kella’s on April 29. Most of
the dead could have lived had
there been all of those projected
3000 such. The late lamented Ziaur
Rahman stopped the project in his
inordinate wisdom. Although you
wish very much to be as if Zia was
again born, the blame of the six or
ten lakh dead is squarely his, and
not even Sheikh Hasina would
hold you responsible for any one
of the deaths on April 29.
But let it be said very clearly,
and understood as such that every
death of the survivors is on you.
How should one describe your
performance?
Colossal
mismanagement? No, that would
presuppose someone tried to
manage but bungled. The powers
of the Bangladesh Government are
puny-but whatever there is to it, is
being held back from being
pressed into play. Madam, the
command over to that hated
creeper of a man, and the nation
will see the difference. And Ershad
was always an actor-a supreme
one in going through the motions.
Even a thing like him,-he sure
would have minted some goodly
money out of his electrifying
performance in the islands-would
have in minutes committed the
whole of the army and all of its
wherewithal. Even he-a liar and a
lecher to his bones-would have
got his mission right-to the islands
and to the inaccessible interiors
without a day’s delay. Thousands
of jawans and sappers would be
there interring the bodies and
——»---- ——------ —
Sunday Express 29
Kaladarshi's column
carcasses-in
Patenga
and
Banshkhali,
in Dhalghat and
Kutubdia,
a
veritble
mini-government would be there in
that old and civilised and literate
island of Sandwip in two day’s
time. And Ershad is decidedly a
bad man and not an efficient one
either. Even he would have-and
could have--reached succour to
the needy before the exertions
becoming quite unnecessary and
hollow.ft
also as a result of a deliberate
attempt to see that people at large
do not feel, take the disaster as
their very own and rise to express
solidarity with the victims in
symbolic gestures as well as by
action-the atmosphere throughout
the nation is one of disinterested
aloofness-might be the cyclone
had hit Hawaii and not Chittagong
and perhaps 50 people have been
killed.
two one-person shows, it would do
well to choose the man inside the
cell rather than the woman in the
helicopter specially for spells of
crisis management.
She has done unfairly for the
body of the nation. What about the
nation’s soul? Well, she has taken
care of that too by welcoming the
chief of a state which was
responsible for killing—by shooting
and bayonetting and burning and
Every death in the hit areas will torturing-millions of Bengalees in
It is painful to compare anyone be on the Prime Minister’s only nine months. Have they
with Ershad. It is more
repented? Are they on
painful to think of the death
record to have accepted
that their 1971 performance
of the lakhs that will be on
Prime* Minister Khaleda’s
fell outside of civilised
behaviour? All they have
conscience. What is she
doing at the moment to alloy
•said to date is that the
the suffering of the millions
bloody nine months were a
case of misunderstanding
that haven’t as yet been
between brothers and both
reached- and to avert any
sides were equally to blame
further death down there?
for it. You welcome him-and
One thing is as clear as a
your press goes very warm
sunny tropical day-1. the
and chummy and gives him
armed forces have very
PM accords warm welcome to Pak PM
all space and prominence in
marginally been involved; 2.
the world-in order that he
less than a speck of what
conscience because of the above
can again throw the ’brother’
government could mobilize by way
and not because utmost efforts
business on our face and promise
men and material and service-and
were made but as the problem was
to do all that in Pakistan’s power.
as it is-has been brought into
too big and the capacity of Dear Prime Minister, you are more
play; 3. the ruling party and its
government and society too
courageous than Hitler. Can you
lakhs of cadres cannot be found
limited, many could not be saved.
say to him, thank you sir, forget
anywhere even by using an
electron microscope-where have
If she has messed up the first about your help, it will smell blood.
they so magically vanished? ; 4. and the most response by woody You are bent on doing us a good
dolly
insensitivity,
her turn-take back some ten lakh of
intentions and attempts by other and
parties
to
share
in
the persistence in the same spells your Pakistanis. They need your
governmental response to the terrifying things for Bangladesh’s help much more than the
crisis has been very rudely brow future. Ordinarily it would be unfair devastated islanders. That you
beaten; 5. every attempt has been to
hold
this
inexperienced cannot do, and you defile the soul
made to make the disaster as not a domestic character responsible for of the nation by subjecting to
nation-sized problem and to show all stately bunglings, but the truth bullying by the man symbolising
that government alone was more is
there
only
Khaleda
in an evil power that has raped our
than sufficient to cope with the Bangladesh, and no government. If mothers and sisters, and killed our
challenge; 6. as a result of this and the nation has to choose between fathers and brothers. And, alas,
Sunday Express 30
5)
Kaladarshi?s column
you choose to do this at such a
time as this.
The Prime Minister met with the
Press on Tuesday-first
time
after
the
catastrophic
swoop.
What she said could be
gotten from the texts of
what the British, the
Pakistani
and
the
Ershadi varieties of
rulers
have
said.
Everything
under
control. Things going
just fine. Reports of
snags and problems
^baseless. There was
nothing from which to
construe that she has
at all understood the
nature of the challenge.
brothers and sisters and children
have
been
removed
and
interred-you present them with a
What happened in
Parliament in the name
of
discussing
the
disaster and consequent
crisis-was- dishonouring
the dead and nothing
beside. You had more
than a major share in it.
The cyclone, the tidal
bore, the devastation,
the
deaths-everything
failed to make you talk a
little softly. Those were
things in the language of
which
God
often
chooses to talk to the
mortals.
Even
that
couldn’t make you shed
a flake from your body of
unflinching arrogance.
But
she
was
apologetic about one
thing.
A delay in
presenting the Master
Plan for rehabilitating
the cyclone affected
people. She pledged
that the plan would be
ready
the
next
day-Wednesday.
- Now who are the
idiots who told her that
the nation was dying
^for a ’Master Plan’ right
at this moment? What
is a ’Master Plan’? You
formulate a 'Master
Plan’ in three days about things
whose parameters would take
months and months to reach you?
You talk of a ’Master Plan’ of
rehabilitating people whom you
have not been able to reach with a
chapati? And before the bodies of
the fathers and mothers and
grave national challenge. Why
have you chosen not to involve
people-which includes men and
women
of
political
f
persuasions? Are they
not your people? Are
your the Prime Minister
of BNP and not of the
nation?
Bodies waiting to be buried
'Master Plan’? Storage. It is going
to be the 'Master Bluff’ of the
century. But no one would hold-it
against you. It shows only your
gullibility
and
lack
of
comprehension of the challenge.
Dear Lord, forgive her
arrogance. Will it be right
for Him to do that? But
He is above right and
wrong. Are we right in
beseeching such? We
are not sure. But how we
wanted the first woman
Prime Minister of our
nation to succeed and further the
cause not only of democracy but
also of setting right the many
social injustices including the
gravest of them: the gender
inequality.
You are a democratically
elected Prime Minister. And you
are avoiding your people in this
Sunday Express 31
Begum Zia did not speak truth
Begum Khaleda Zia has not spoken the truth. She
is on the record to have told the Parliament that Ziaur
Rahman built a number of cyclone shelter in the
coastal areas.
But the fact unfortunately is otherwise. The need
for 2,000 cyclone shelters and forts (centre for
animals) was felt after the devastating cyclone of
November 12, 1970.
After
independence
the
Awami
League
government built 238 cyclone centres and 137 forts.
Another 42 forts were under construction and made
complete later on.
During the reign of Ershad, after 1985, 62 more
cyclone centres were constructed. But, Zia
government did not construct a single one.
Bravo Major Mannan ’
State minister for textiles, Major (Retd) Abdul
Mannan went to see for himself the condition of
cyclone affected people of Chittagong. His arrival at
the port city was widely announced over mikes in
Kalurghat Commercial area. The workers of the area
waited in long queues for his arrival. One reason was
that Kalurghat was badly battered. The workers
expected of the state minister to bring for them relief
materials. But alas, their wait turned into frustration.
Escorted by police, the state minister for textiles
arrived there but not to stop to talk to the workers. He
drove straight to his own garments factory "AzimManman Garments". His factory too was damaged.
After visiting his factory, he left Kalurghat. Somewhat
surprised, the owners and employees of the area
consoled themselves: ’perhaps the minister was too.
moved seeing the damage to his factory to remember
that he was not only an owner of a factory but also a
minister as well. The minister however was quick to
follow his chairperson Khaleda’s footsteps and
announced he would not receive his salary but
donate to people’s welfare.
PM has no respite with guests
The prime minister has to receive too many
visitors these days. On the list qf guests were
Pakistani prime minister, Newaz Sharif, French
Sunday Express 32
Minister for Humanitarian Actions Bernard Konchner
and Nobel Prize winner philanthropist Mother Teresa
who visited Dhaka at the same time recently. The PM
accompained by them went on a visit to the
cyclone-hit areas. At the time of their return flight, the
already rough weather turned further foul. The
helicopter carrying them was forced to land'at
Munshiganj. All felt relieved that the dignitaries were
safe and sound.
But what transpired is that the weather too grew a
little nasty because that is how it thought it could play
prank on them. Quite a way to make them realise how
helpless people are before nature here.
Pak PM’s nightly stay ■'
Newaz Sharif, Prime Minister of Pakistan came to
Bangladesh to express his solidarity with the’
cyclone-affected people on May 5. He was supposed
to return to Pakistan that very evening. But the Press
was contacted at night with the message that the Pak
PM had to halt his journey home because of foul
weather. He left next morning alright.
But a reliable source informed on the night of May
5, the Biman flights continued as scheduled in the so
called rough weather. The question is: was there
anything mysterious behind Sharif’s overnight stay?
PM’s business
•*
•
Prime Minister Khaleda Zia, while busy with relief
operations,
found
herself caught in awful
circumstances. As the chief of the government’s
Relief Co-ordination Committee, the premier over the
past few days has been shuttling between the capital
and the port city Chittagong and other coastal fdistricts to monitor and supervise the relief
operations. During this period, she chaired several
meetings in Chittagong, to discuss relief activities.
Informed sources say the meetings were held in
different venues in accordance with the premier’s
intentions. These sources speak of at least three
venues: 1) Circuit House, 2) BJMC Rest House and 3)
The residence of late Mr. A.K. Khan, father of Ershad’s
alleged paramour Zeenat Mosharraf. However, the
sources could not say anything about the reasons
behind the PM’s whims.
v
-;Hasan Iftekhar
REPORT OF CYCLONE RELIEF WORK DONE
IN
ANDHRA PRADESH
Thelma Narayan^ Intern
StoOohns Medical College
SUMMARY
We worked in association with the Catholic Cyclone Relief Organization
(H.Q® - Vijayawada)9 as the Medical team.
Both aspects of medicine-
preventive and curative were practised.,
INTRODUCTION
The first Medical team of volunteers left on 1/12/77®
They
joined the above organization and started Medical relief®
The
2nd team (with 10 members) led by Dr® Padmini Ursp of which we
were a part worked from 12/12/77 to 29/12/77®
We worked in the
4th team with 2 members from 9/1/77 to 31/1/77®
DATA REGARDING TIDAL WAVE AND CYCLONE ON 19/11/77
1>
Tidal wave - 25 feet highP 60 km longy penetrated 12 km
into coastal Andhra and lasted for 6-8 hours®
It changed
direction 4 times
2.
Speed of cyclone - 120 - 200 km per hour
3®
area hit by cyclone - 8?453 sq® km
4®
Population affected by cyclone - 25?00e000
I
5®
Krishna and Guntur
Districts were severly affected and
adjoining districts to a lesser extent®
In Krishna ^ist - 53 villages affected
Guntur
Dist®
West Godawari
dist®
- 24 vilages
-
4 vilages
o
9 O 2
6.
In the catastrophic zone covering Diviseema and part of Bandar
taluq’s over
50,000 people are feared dead and also 100,000
heads of cattle lost,
Havoc caused by cyclone related mostly to property.
7.
Tidal wave
related to human lives, livestock, houses, property crops.
Camp and organization
Our camp was based at Nagayalanka, Divi Taluk Krishna dist, on
It consisted
the frunge of the tidal wave affected area.
people divided into 3 teams
- i
of 60-70
Relief team
ii
Rehabilitation Team
iii
Medical team
The aims was to take up certain areas for development which would
consist of 3 chases -
i
Immediate relief
ii
Intermediate phase
iii
Long term development phase
at first an exploratory team with a representative from the medical
want to survey a village as regards amount of destruction of life
and property, and relief measures already taken by other agencies
to avoid overlcp
of work.
Information was obtained by meeting the
village president/Sarpanch and by going around the village.
The
villages chosen were those in which no organization was working with
a long term project.
6 villages with surrounding
hamlets were taken
up and alloted by the Govt, to this organization.
Method of work in a village
Immediate relief consisted of providing food, clothing and shelter
ie building long community huts.
a statistical team went around collecting baseline data viz
Male
number
I
°F living
F emale
Census
Number of dead
•.«3 •
3
Socioeconomic survey regarding
II
Housing
Occupation
Property
-
Education
( see charts)
on the basis of this, requirements were calculated and
plans drawn
up •
Medical work
(during first stay)
When ues a r i v e d, there were 3 clinics established
i)
At Nagayalanka
population
~ 9000
It also covered surrounding villages
ii)
iii )
At Mandapakala
population - 1,311
Mobile clinic - going from village to village covering
a population of <=■ 2,458
clinical work was done during the day 0 Daily statistics
of cases
inQ
were kept with a graph showing of the distribution pattern of diseases
This was classifed as follows:
1)
Total number of cases
2)
^iarrhoea and ^ysentry
3)
Gastroenteritis^
4)
Respiratory Tract Infections
5)
^ther Infections
6)
Miscellaneous
^ur team leader kept in contact with the D.MaO* at the nearest P.H.C.
at Avanigadda 18 km away.
They were very helpful and supplied us
with DDT, bleaching powder, lime and drugs to supplement ouf own
stocks of medicine*
Most, of the population were already innoculated against typhoid and
Cholera and there were no epidemics,
Preventive work done included - Remaining TABC
innoculations, Tetvac
innoculations, Chlorination of wells, spraying of bleaching powder/
lime constructions of trench latrines for the camps, health education
to the villagers regarding environmental
sanitations, nutrition,
boiling of water for children etc,
Observations/Discussion
1,
The population covered was not a normal population having first
suffered an enourmous loss of life and property,
2,
Most people had returned or had to be coaxed back to their own villages
as §11 they had left was their land without which they would.
•> -"S
become beggars or slum dwellers in same town,
3,
These people were building life afresh and were ideal ground for
community development,
4,
Every family had been disrupted due to loss of same or other or
many members causing a large social problem,
5,
The mental health problem was large and acute, the people still
dazed or depressed,
6,
^ese people were fairly well-off prior to the cyclone/and
poverty is new to them (see charts regarding property).
avoid them getting used to obtaining things
the begging,
To
easily first for
some sort of cooperative venture where they
provide at least the labour is desirable,
A team of village leaders could be the decision making and
negotiating body,
system was noted in one village (Etimaga)
which was 'divided into 10 divisions, each of which had a
leader who would put up the requirements of that area and get
M
the work done.
They themselves a had completed the harvesting
and started rebuilding,
7, Illiteracy and ignorance were found to be very widespread ’
(See charts) only 2—3 persons are educated above the 10th
std.
These could be involved in the development programme.
Most of the population were already innoculated against typhoid and
Cholera and there were no epidemics.
Preventive work done included - Remaining TA8C
innoculations, Tetvac
innoculations, Chlorination of wells, spraying of bleaching pcwder/
lime constructions of trench latrines for the camps, health education
to the villagers regarding environmental
sanitations, nutrition,
boiling of water for children etc.
Observations/Discussion
1O
The population covered was not a normal population having first
suffered an enourmous loss of life and property.
2o
Most people had returned or had to be coaxed back to their own village
as §11 they had left was their land without which they would.
become begga.rs
3S
or slum dwelle.’rs in same town.
These people were building life afresh and were ideal ground for
community development.
4.
Every family had been disrupted due to loss of same or other or
many members causing a large social problem.
5.
The mental health problem was large and acute, the people still
dazed or depressed.
6.
These people were fairly well-off prior to the cyclone/and
poverty is new to them (see charts regarding property).
avoid them getting used to obtaining things
the begging,
To
easily first for
some sort of cooperative venture where they
provide at least the labour is desirable.
A team of village leaders could be the decision making and
negotiating body*
system was noted in one village (Etimaga)
which was e-cfivided into 10 divisions, each of which had a
leader who would put up the requirements of that area and get
the work done*
’■V
They themselves a had completed the harvesting
and started rebuilding.
7. Illiteracy and ignorance were found to be very widespread 1
(See charts) only 2-3 persons are educated above the 10th
std.
These could be involved in the development programme.
5
So
The social problem of the Harijans was noted,
coolies as they did not own any land*
They worked as
In one area they had land
but without any irrigation facilities®
9o
Health
- as this was a food growing area the gneral health of the people
was good without much protein-calorie malnutritions*
Anaemia
were found to a ac: ute mainly in women and children®
- There were no epidemics of cholera, typhoid
or gastroenteritis
The reamining few
due to early and complete innoculations®
were caused by us®
- There were no epidemics of cholera,
- Initially the graph showed a high incidence of respiratory
This was due to -
disease especially U.R.T.I
i)
x
ii)
exposure during tidal wave and cyclone
k
Lack of adequate shelter and clothing
iii)
Cold
iv)
Dust and fumes
weather expecially at night
I
This fact was brought to the notice of the organizers and priority
Large community
was given to providing clothing and shelter®
huts were built immediately®
Individual families also started
building huts from palmyre leaves and bamboo provided by Govt®
ater was obtained mainly from tube wells®
The few open wells
were cleaned out by the army and chlorinated by the PHC staff®
subsequent chlornation was done by us® Tube well water was used
without purification generally®
Some of the tubewells were
located close to drains/canals and were probably sucking in
water from them®. In one area an outbreak of Gastroenbntis was
found among users
of water of one such well®
Csjses presenting
with diarrhoea and dysentry pwere advised to boil water, expecially
o
practical
, .
o
o
.
for children -not very
suggestion for whole families.
Two cases of infective helpatitis were seen.
- Gnviornmental Sanitation
were additional factors
was very poor
following the
ha,voc
viz occasional corpses and carcasses
uprooted trees, debris, stagnant saline water.
^his combined
with the ignorance of villages concerning the subject.
the latter half of out stay, there was a marked
Towards
increase in the
number of flies with a corresponding gradual increase in the
incidence of diarrhoea and dysentry.
•••6
Only sporadic cases of gastreenteritis were seen who responded to
treatment.*On follow up no furthur cases were found in the surrounding
areas o
The D ®M . 0. at Avanigadda was informed of the fly menace^
Bleaching
powder and lime were obtained and sprayed around the villages by
teams from the PHC and our camp.
A fairly significant number of evening fevers with chills presented
to us9
a few clinical cases of filaria with swelling were seen®
rest were ?
Malaria ?
The
Filaria.- Mosquitoes were more around
^’agagalanka and the canals of the Krishna river4Nearer the coast
there were pools of salt water brought in'by the tidal wavee
- Mental Health
The majority of cases needed only a sympathetic ear, as everyone
in the area has a story to tell®
4-5 cases of hysteria
were seen.
it is impossible to rub out the experience these people have had
and many of them have told us that they wish that they too were dead®
But the most important thing is to give them same hope to start life
again and so the programme was called ’’Operation Hope”. Two priests
stayed at
gorgepetta to encourage people to return to their land®
In that village not a single house remained? 100 people had died
and 146 were living comprising 40 families?
in one large hut a kitchen
garden was planted to prove that the soil could still be productive.
fowls were kept to bring back same
provide eggs for the villagers®
semblance of normalcy and to
•/
•
The Lancet ■ Saturday n September 1971
•
A MINE AND CIVIL WAR
IN EAST PAKISTAN
Lincoln C. Chen
Jon E. Rohde
Harvard Medical School,
Massachusetts 02114, U.S.A.
Within a year, East Pakistan has been
■„^r,‘,ary struck by severe flooding, a devastating
and civil war. Food production has fallen
Successive years, and the food deficit is the
dn.ee the Bengal famine of 1943. Imports of
tons of grain will be needed to give an
X. pcr-caput consumption of 1600 calories, which
j«n>t enough to prevent frank starvation. In
'"~cicnt situation, with transport services much
the chances of achieving this seem poor.
jsstrition, in a normal year, reaches its worst in
■.x-^ber; this year the food shortage may affect
JrLL'ion people. The Pakistan Government has
■ rdcnowledged this crisis, and the opportunity
7r»cnt a major famine is fast slipping away. An
gaaxional, neutral team is required in East Pakistan
the relief supplies required, to supervise the
of transport facilities, and to ensure the fair
J cadent distribution of food.
;
%.
■
■ "
Introduction
|
E
3
feI
p'
I
{
I
1
most common medical problem in the world
u hunger. In this century we have witnessed
J Cibeme form of this condition in the many
which have struck Asia (flood and drought),
? ^Vddle East (locust and earthquake), and Africa
L??30
Nigerian civil wars). With accelerating
growth, mankind will repeatedly face
for years to come. Nevertheless, early recog^3»aac^ treatment can, as with most medical prob^sen
greatly alleviate the impact of famine.
exists today in East Pakistan, where
. most disastrous man-made tragedies of this
’infolding. On March 25, 1971, a civil war
•^aSt ^a^stan> and the agricultural and
^location following this conflict has pro^impeded. Although hunger has not yet
\ .-qU anpne proportions, mass starvation threatens.
reP°rt will focus on the rationale for
international intervention if we are to
most severe famines in history.
^^’ed •
|
Background
tithe ofttle GanSes Delta, East Pakistan was joined
Partition of India in 1947 to a geographically
' Alrtw/ dissimilar West Pakistan some 1200 miles
■^^24
^eSt Pakistan, has 80% of the country’s
•' I . •
••
total area, East Pakistan’s 78 million people Constitute 56%
of the total population. The'annua! rate of population
growth is uncertain but is about 3%. The population
density of the region is amongst the highest in the world,
averaging near 1500 people per square mile. The abundant
rainfall of the monsoon and the fertile silt soil carried
down the Ganges, Meghna, and Brahmaputra rivers pro
vide ideal conditions for an agricultural economy. Rice is
the major crop, and smaller amounts of cultivable land are
used to grow jute, tea, and sugar.
Despite the agricultural orientation of the economy,
hunger and malnutrition are endemic to East Pakistan.1
The basic diet consists of rice supplemented by curries
made from vegetables, fish, and lentils. Meat and dairy
products are a rare luxury, and fruit consumption is
entirely seasonal. Intake of cooking fats and oils is scanty.
Cooking practices often lead to substantial loss of essential
nutrients such as vitamin C, thiamine, and niacin. Social
customs further exacerbate the dietary imbalance. The best
food is reserved for the adult working men while women
and children receive the left-overs. This practice may
provide the necessary energy for the wage-earner to support
his family but neglects those who require special nutritional
consideration.
In 1970, the average daily per-caput cereal consumption
was 16-1 oz.—consisting of 14-8 oz. of rice and 1-3 oz. of
wheat.2 This provided only 1700 kilocalories (C.) per
person per day compared to a U.S. and West European
average of 2700 C. Owing predominantly to economic
restraints, the consumption of essential proteins and vita
mins is insufficient. In a recent survey, the average protein
intake was considered inadequate in 85% of the rural
population.1 Borderline malnutrition affects over 50% of
preschool-age children. Approximately 3% of children in
this age-group suffer from frank malnutrition, traditionally
classified as kwashiorkor and marasmus. These deficiencies
are reflected in child-mortality and growth-retardation
statistics. The death-rate among all liveborn children is
26% before their fifth birthday, compared with a European
average of 2-4%. Although birth-weights in East Pakistan
arc not significantly different from the European average,
disparity in weight gain becomes striking from nine to
twenty-four months. Thereafter, child growth in East
Pakistan parallels growth of European children, although
remaining well below the latter in absolute terms. Despite
the uncertain contribution of genetic factors to this dis
parity, it can be assumed that malnutrition plays a signifi
cant role in the retarded growth observed in the average
East Pakistan child.
Health problems relating to specific deficiencies also
reflect inadequate nutrition. Vitamin-A deficiency, leading
to keratomalacia and blindness, affects 4 children out of
500 under the age of five years. Similarly, riboflavine
deficiency, ahasmia, goitre, and vitamin-C deficiency are
common. Epidemic outbreaks of cholera, tuberculosis,
diphtheria, and smallpox occur regularly. Although spread
of these diseases is predominantly due to poor sanitation
and health practices, undernutrition may also play a signifi
cant role. Diarrhoea associated with malnutrition, often
resulting in death, is not uncommon.
s
-r <
©
•*
C H C
II
For restricted
circulation only
Not to be quoted
Notes on a year of Travel
and reflection - 1982
Community
Health
Cell
Centre for Non-formal & Continuing Education
"ashirvad" s 30 St Marks Road s Bangalore 1.
»
558
t>
the lancet, se
TABLE I—EAST PAKISTAN: SUMMARY OF PRODUCTION OF RICE 3
Production (million tons)
Fiscal year
1960
1965
1970
1971
1972 f
A us
____________ .
2 09
2-50
2 96
2-86
247
A man
Boro
Total
5 99
7-26
695
5-91 •
567
0-40
0 57
1-90
2-20
1-50 +
8-48
10-33
11-82
10 97
9 64
Aus (April-August), anian (July-November), and boro (DecemberMay) refer to three different cultivation times.
* The amen crop of 1971 was affected by Hooding, cyclone, and civil war.
v Projected production for 1972.
t Yield of the boro crop depends heavily on fertiliser, irrigation, and
pesticides.
Impact of Civil War
The civil war in East Pakistan has crippled agricul
tural production. From 1966 to 1970 East Pakistan
produced an average of 10-8 million tons of grain per
year but still required a yearly import of 1-2 million
tons to offset chronic deficits.2 Even if the Fourth
Five Year Plan of increasing production to 16-7 million
tons were realised, East Pakistan would still require
importation of an additional 1 -4 million tons in fiscal
1975 to feed its expanding population. However,
anticipated growth of food production did not materia
lise in fiscal 1970. East Pakistan was struck, in suc
cession, by the severest flood in a decade during
September, 1970, the worst cyclone of this century,
which devastated the coastal, rice-producing region in
November, 1970, and a massive military campaign
sweeping across the countryside beginning in March,
1971. Thus rice production fell to 10-97 million tons
—680,000 tons short of expected yield.3 Because strife
continues, projections for this coming year suggest
that indigenous food production will not exceed 9-64
million tons (table i). This represents a shortfall of
2-28 million tons below pre-civil-war estimates, and a
reduction of 20% in crop yield. East Pakistan now
faces, for the first time in recent memory, reduced
production in two consecutive years, and the largest
food deficit since the Bengal famine of 1943.
Many factors have contributed to this rather bleak
prospect. Hundreds of thousands of farmers have fled
into India to escape injury and death arising from
military actions against civilians.1 Farming operations
have been crippled in many rural areas, especially in
those border regions adjacent to India. Lack of ferti
liser, pesticides, seed, and fuel for irrigation pumps
has contributed to the lowered output. There has
been a total collapse of the agricultural credit structure.
Cessation of public works programmes has resulted in
TABLE II—CALORIC ALLOWANCE IN FAMINE AREA (C.) 0
Age group (yr.)
Emergency*
subsistence
Temporary f
maintenance
0-2
.............................
3-5
.............................
6-9
.............................
10-17
............................
Pregnant or nursing women
Sedentary men
Sedentary women ..
Moderate labour
Heavy labour
Very heavy labour ..
1000
1250
1500
2000
2000
1900
1600
2000
2500
3000
1000
1500
1750
2500
2500
2200
1800
2500
3000
3500
•To arrest the downward progress of undernutrition.
f To permit slow recovery.
widespread rural unemployment and sho
Governmental and private business
been at a virtual standstill.
j
Urban location of existing imported
further exacerbate the food deficit in
Because approximately 90%of the pcpu’-J^
and an estimated 60% of the urban
fled into the villages, most of the food reS
will be in the countryside. Yet over
. —
grain storage is found in three major urban" *’
Dacca, Chittagong, and Khulna.2 In addiric^?^' :
activities have disrupted food markets.'traders who anticipate an impending < V
larger profits has already raised the frceXiS
of rice.
'
■
Prospects of Famine
. Although the total food gap is uncertain, h ;mated that some 2-9 million tons of
•’required to supplement indigenous production
to maintain the population at an average
of 15-0 oz. per caput per day (1600 C.).’ 1600C tT*
be considered marginal to prevent frank
As shown in table II, even the sedentary aduh ~
1600-1900 C. per day to arrest nutritional
•'
tion.° The calculation of 15-0 oz. assume! C-». f
7-5 million refugees who have fled into Indu e'
1
at least partially replaced by predicted P.71L i
gains (table in).
The maximum import cf {..
grains in any normal year thus far was 1 -5
C
in 1970; thus the prospect of importing and dherf*
ing 2-9 million tons under present circumsc*?*^;
poor. Chittagong, the largest port, is opezs^ .
well below capacity, due primarily to th: tr? \
many of the workers have fled. The smaller rru f
Khulna and Narayanganj are similarly handje^tt
Even if large quantities of grain could be
and offloaded, the ability to transport these ■—%
TABLE III—AVERAGE AVAILABILITY OF FOODGRAIN3
IN FISCAL YEAR 1972 AT VARIOUS LEVELS OF FOO^&A?*
AND POPULATION 3
Foodgrains per person (oz.) assuming 7^*
(millions) of:
Foodgrain
imports
(million
tons)
782
77-2
29
25
2 1
17
1-3
14 6
141
13 6
13-1
12-6
14-8
14-3
13 8
13-3
12 8
76-1
1
___ —
150
14-5
14 0
13-5
130
1
!
,
-
-••
15?
14 '
14
2
r?
I
13 2
If one were to assume that nil of the refugees
ately (population 78-2 million), 2-9 million
imports would provide an average of 14-6 ozIf the number of refugees who do not return to
daily replaced by the expected increase in
greater than 2 million), 2 9 million tons of
an average of 15 0 oz. per day for 76-1 million i
’
ci
.
V
A.
.
deficit areas is severely limited. In
' c&Z*
imported goods were transported
f
inland by rail, 38% by water, and Recent reports indicate that many rai
*
roadways, ferries, bridges, and tru*.^ ^-5
destroyed or severely damaged. Thus
estimated to be no greater than 20%
30% of normal.7
Water transport)
feasible, has also been curtailed by the
I
I
*4
c'} of
impending famine is hazar^rorical perspectives will add to our
.
current trends in East Pakistan.
.
feed shortage can be divided into
- scries
drought accompanied by
-d less of seed; diseases such as fungus
locusts; war and civil disturbances;
i
Other contributing factors
zzzi of normal communication and
which can lead to starvation even in
-are relatively close to foodz.fcsa striking still is the presence of
:xlsqu2te food supply, caused by the
local economy and complete loss of
by the poor. Small-scale hoarding
; ecu turn a marginal food deficit into
-.Although famines can usually be
• -T.2 major factor, often the simultaneous
vevural factors exacerbates the situa-
'-7j the first and most obvious effect of
•. vrstiaj of adipose tissue.8 Abdominal
'•viscera become reduced in size, and
-::a atrophies, leading to poor absorptive
‘ diarrhoea. “ Brown atrophy ” of heart
"?~’cLcd with falling blood-pressure and
■ hir becomes dull, and the skin acquires
’ ey of paper. “ Famine oedema ” develops
y wa^r dees not decrease corresponffssue mass declines. Psychologically,
cr apathy accompanies an obsession
is.usually due to intractable diarvictims are found amongst the weak,
rang; surprisingly, women and adolcs*' better than adult men.
0
►
•
I *1
’ Greatest famine in our lifetime was the
1S£3. It is estimated that some 3 million
ivmomqn. Ghosh has described the horror
• a .'mere skeletons covered simply with
7-QS for their last breath; mothers hugging
c.esd children, unable, having no strength
practically in delirium precedent to
~.ernes or a few hours after crying for a
: f • * Haggard, half naked women worn out
rickety babies with dried up limbs
- faces, small children with bloated bellies
-•-3 cut. .
'
Bengal during
uuring 1943
1^0 was accompanied
-2a disintegration; suicide, selling of chil-•
V*
slavery, banditry, and disruption of
prevailed. Those who did not
lUced epidemics of cholera, smallpox,
'%spread by the breakdown of sanitathousands of starving people
.
centres such as Calcutta in search of
* OU. route or to meet with continued starva* r>^u—
*■
I
-
Bengal famine in 1943 was shortPolicy. The British Administration
’
attention to reports of food
° Respite the virtually complete
j
from war-torn Burma, exports
decrease proportionately. In addition,
Purc^asin8 foodgrain for the
■. •. ■ \
response to rising prices and food
T'? ^Steering, and speculation increased
The entire problem was further
”
I
—>
• i
Seasonal variation of kwashiorkor and marasmus in East
Pakistan.
exacerbated by the “ denial policy ” aimed at denying
foodgrains and transport facilities to the enemy should
they attack India. The impounding of some 25,000 boats
handicapped the cultivation of the small islands in the
Bay of Bengal, curtailed the fishing industry, and prevented
adequate transport of food from excess to deficit regions
within Bengal.
The similarities between the famine of 1943 with
present trends in East Pakistan arc striking. Some 2-9
million tons of imports will be required to offset the
deficit in indigenous production, but the Pakistan
Government has failed to acknowledge this crisis, much
less initiate effective programmes. Already, hoarding
is taking place, and the market price of rice has risen
sharply. Much of the existing food stocks have been
taken to the military cantonments to feed the army.
The malnourished state of the 7-5 million refugees
who have fled into India attests to the deteriorating
situation within East Pakistan.
The critical period lies immediately ahead. Reliable
estimates project that the current food shortage will
affect approximately 25 million people: the landless
labourer, deficit farmer, craftsman, factory worker,
and urban poor 3; the number that will die of star
vation is unknown. In any normal year, the prevalence
of malnutrition increases progressively until harvesting
of the major crop (aman) in November (see figure).
The present crisis compounding this seasonal variation
of malnutrition may precipitate a famine of unprece
dented proportions over the next three months.
What Can Be Done ?
Experience in Biafra10 and current practices in East
Pakistan 11 have shown that military control of food
supplies can be a powerful weapon of suppression.
Bacteriological and biological warfare have been re
nounced by international convention.Starvation
should similarly be outlawed on the grounds that it
selectively affects innocent children and the elderly.
International opinion should demand that opposing
parties in East Pakistan permit sufficient food to
reach all affected civilians, regardless of their loyalties.
Food distribution under close, impartial, third-part}7
supervision can alleviate suffering and diminish, if not
5
560
prevent, widespread starvation.10 A sizeable, neutral,
international assessment and surveillance team should
be permitted to enter East Pakistan:
(1) To determine the geographical distribution of the
population in the light of recent migrations;
(2) to assess current stocks of foodgrains in both Govern
ment and commercial storage facilities;
(3) to determine the quantity and type of relief supplies
required;
(4) to evaluate the extent of damage;
(5) to supervise the repair of communication and trans
portation facilities to be, used for non-military purposes
only;
(6) to establish distribution centres accessible to water
and air transport throughout East Pakistan; and
(7) to formulate equitable procedures of rationing and
distribution.
•. ,
Lessons learned from the international relief effort
after the cyclone of November, 1970, in East Pakistan
can be extended to the present situation. From East
Pakistan’s nine operational airfields', existing food
stocks should be flown to local distribution centres to
cover immediate needs. Air transport must be supple
mented by seagoing vessels, equipped to transfer
foodgrains directly to smaller craft while standing
offshore. These small craft can utilise the extensive
waterway system to deliver supplies to regional centres.
These procedures would circumvent the problems of
congested ports and decreased rail and road capacity.
The opportunity to prevent a major famine is
rapidly slipping away. Responsible members of the
world community, concerned with human welfare,
must insist that strong action be taken now. Unless
we respond, the reports of famine in East Pakistan
during the next few months will weigh heavily on our
conscience.
“ There they stand, heads bowed,
'
Mute; on their pale faces chronicled the sufferings
Of many centuries; on their shoulders they bear burdens
Which grow; carrying on, slowly, till life holds,
And then they pass them on to the children, for generations.
Fate they do not curse, nor complain, remembering the gods;
Men they do not blame, nor cherish any pity of love
For themselves; only a few grains of food they glean,
And their tormented Eves, somehow, keep alive.
When even that meagre food someone robs,
Or hurts their life in blind might’s cruel oppression,
They know not to whose door they will turn for justice;
Calling on the God of the Poor, for once, in their heaving
sighs,
Silently they die.”—Rabindranath Tagore.
REFERENCES
1. Pakistan: Nutrition Survey of East Pakistan: March, 1962January, 1964. A report by the Ministry of Health, Government
of Pakistan, in collaboration with the University of Dacca and the
Nutrition Section, Office of International Research, National
Institute of Health, U.S. Department of Health, Education and
Welfare, May, 1966.
2. East Pakistan: Foodgrain Situation and Prospects. World Bank
Report, April, 1971.
3. Rice Production in East Pakistan. Prospect for the year 1971-1972.
United States Agency for International Development, July, 1971.
4. A’ew York Times, June 30, 1971.
5. Wall Street Journal, July 27, 1971.
6. Passmore, R., Davidson, S. Human Nutrition and Dietetics.
Edinburgh, 1963.
7. A Report on the Food and Transportation Situation in East Pakistan.
U.S. Department of Agriculture and Agency for International
Development Mission to Pakistan, June, 1971.
8. Mayer, J. Postgrad Med. 1965, 38, Al 17.
9. Ghosh, K. C. Famines in Bengal 1770-1943. Calcutta, 1944.
10. Report of Biafra Study Mission. Congress. Rec. Feb. 25, 1969.
11. New Statesman, June 4, 1971.
d'N /Vc’/g ££ _
UN
crr7^r-)
N-&. jp. cj
S fl C T I 0 IT
*"5/ lC‘t53c!I
3
IV
ITA7.TH
138* The refugees faced specially grave health hazards.
1
Kany were
wounded by bullets or shrapnel when they rea.ohed India and had to be
hospitalized and operated upon.
irch
They were weakened by a long and tiring
and the rations they received did not always meet fully their
caloric and protein needs<»
This gave rise in course of time to protein
deficiency diseases, particularly amongst the children.
On the way to
India, some of them fell victim to cholera and carried this disease with
them to the camps.
There, over-crowding, the lack of safe drinking
water and generally unsanitary" conditions not only compounded the risk
of cholera, but also produced gastro-enteritis and skin diseases.
With
the arrival of the cold season, diphtheria and diseases of the respiratory
tract added a new threat.
The sheer number of the refugees made it a
gigantic task to keep the health situation under control.
Some of the
major problems involved are discussed in this section.
A.
kSBICIIriS /u~i) 1 UDICilL' SUH/UfS
139* One of the main dangers encountered in the early days of the influx
was the spread of cholera.
In the beginning, efforts were focussed on
preventing the outbreak from turning into a major epidemic which would
have affected not only the refugees, but also the local population.
The
threat was particularly ominous in West Bengal where an outbreak of
cholera in the urban conglomeration of Calcutta could turn into a major
disaster if preventive measures were not promptly taken
4
-•«
140- When it became clear in April 1971 that the refugee influx was going
to swell, the Central health Ministry of the Government of India began
to plan fox the stock-piling of basic drugs, for issue to the various
states involved.
The two Central Medical Stores Depots at Calcutta and
Gauhati were instructed to undertake emergency purchases of medicines.
However, apart from considerations of cost, the massive quantities of
medicines required were not available in the country, particularly to
combat cholera.
The Government of India turned to the United Nations
for assistance«
141 • The first estimated requirements of medicines for the refugees were
submitted to the U.K. Focal Point by the Department of Rehabilitation of
the Government of India in lay 1971*
The note stated that the -finis try
of Health planned to build up stocks of medicines in a value of
$ 2.5 mill i on-t,
However, after detailed technical discussions between the
World Health Organization and the Ministry of Health, the immediate
requirements of medical supplies and equipment were reassessed.
On
4 June 1971, the Directorate General of Health Services conveyed the
following list of urgent requirements to WHO, with a request that these
medicines and equipment be airlifteds1.
Rehydration fluid for cholera with
giving- sets
25O,OOC litres
2.
Anti-cholera vaccine
500,000 doses
5.
Jet gun injectors
4.
Disposable syringes
5.
Tetracycline tablets 50 mg.
s
•
50
100,000
*
1,000,000
- 70 -
6<
Choloroquine tablets
10,000,000
7«
Paramquine tablets
1,000,000
8,
Daraprin tablets
200,000
142o Other requirements were subsequently formulated, for the second
phase of the programme.
14?° NHO immediately started to procure and airlift the most urgent drugs.
Table 2
at the end of this section which shows the medical supplies and
equipment provided through the United Nations system, reflects the truly
international character of this effort.
144. Subsequently, requirements were periodically reviewed by the Health
IHII
Sub-Committee of the Central Coordinating Committee,
consisting of
Representatives of the Ministry of Health, the Indian Red Cross, the
World Health Organization, UlTIc.ji<} and the United Nations Focal Point
In the Ministry of Health itself, a special unit was eventually established
to deal exclusively with the refugee situation.
145. As mentioned above, medicines in the very early days of the emergency
came from Government stocks held in Calcutta and Gauhati.
As the refugee
influx continued and the Central Health Ministry undertook to build up
considerable stocks of drugs, it opened four additional sub-depots at
Agartala (Tripura), Dhubri and Karimganj (in Assam) and at Tura (in
Meghalaya).
The Central Government also appointed liaison officers at
Calcutta, Shill eng and A,;:rtala to help in the speedy issue of medicines
to the State Governments from the Central and Sub-Depots.
' -*•
« *
71 -
' 146. As will be shown in Table 2 at the end of the present section,
medicines and medical supplies contributed in cash and kind through the
United Nations Focal Point amounted to
I).
76$345«
HOSIIIALS -Ai:D CLINICS
147. Although the existin’ medical facilitie
of the states where the
refugees had sought asylum v.rere soon strained to the maximum,
w; they were
obviously unable to meet' even the most urgent medical reauir events.
Central Ministry of Health therefore endeavoured to
facilities in the camps themselves.
The
create new health
The norms laid down provided for one
bed for every 2,000 refugees at a cost of Rs.J,500/- by way of initial
construction and equipment costs and Is.2,000/- on maintenance for a period
of 6 months.
Thus for a camp of 50,000 refugees, which was the planned
size, for instance, of the “Central” camps, it was planned to have a
25-bed hospital;
in addition tyro health centres, or dispensaries, were
also planned for such camps.
A typical design approved, by the Government
of India for a 25-bed camp hospital is shown on page 75
148. As was the case in other sectors of the relief prograjitu
and as is
evidenced by the data shown in Table 1 at the end of this section, these
norms were not uniformly applied in practice.
of reasons:
This was due to a number
shortage of time, the existence in certain areas of local
hospitals and clinics where the refugees could be treated (sometimes at
the cost of building some temporary extensions), or the existence in the
vicinity of the camps of medical facilities established by various voluntary
agencies, which made construction by the Government redundant.
However,
over 1,700 new hospital beds were'provided in existing or new hospitals,
APPENDIX-Z
C-’o
14-0 (-’PMOx)
V SRAMDAP
4-
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o
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kitchen.
1
'J
DAT. DAT
^AT.
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Q
I1
□
2
Mfr i
2
d
1
13
*
MEN
NO. C.
LU
id
—4
TYPICAL HOSP.DESIGN FOft,
STOM?
class jy
ACCOMMODATE OFBISPUCCD PE 1ST
HOi.STAF?
(4'^’;
1
I2f-o*
1
*
0aC.^O.SA^/537 I SCALE-1*JM6rO
I4-®!
IZ-O*
DEALT e>y- ?. C»Ay.?LU':y p/j £p s e PT • 71.
1
NO. D.
SPX-M.CflASRZ
mote :
KEY PLAN
5?/T.'4Ei.BACMAU SO/K.M.NtCAM
.c£g.y?*CTt
TWJO DR^ MAS BLEW PREPARED A« PCt2 THE
VE.R.BAU IMSTR.UCTION& fcY- 9»» K VUOAyACHA-LAM C.C. (£.Z ) TO TU£ A R.CHITE CT SX1 T.K.O. EAXX1
it;
i2‘- o’*
••
[sister
SEJJiGS. A’LCHITECT
C.P.VAD. CA LOUTTA
A*. O
—1
staff
9.Q,, a as hi y
Appendix- vl.
NOTESi-
THIS DRG.HAS SEEN PREPARED AS PSI
7HE VERBAL INSTRUCTION BT SRI K
hHCMKSf CURSES .
VVDATACNALAM C.E. (E.-2.JTo THE
ARCarTEC-T T.K.D. BARMAN.
t4‘« oVaprox)
•
•
G
0
Io i^p ASG A G x.
2
•
Df
m
12 Women
9
STORE
class bl]
HO5. staff’
2
<
Of
ui
typical HOSP, design for
ACCOMODATION Of DISPLACED pERSOU
QRG*N0» SA(c;/<g38 9GALE‘-r=IG-o"
DEALT BY.p.CHAKRAVSm DATE SEP.’ 71
No. b.
M-CMAWUIVFFn T<K-D-BARMAN K.N.NlGAI’
A17T« ARCM.j&RCMnECT
SR. ARCH-
KEY PLAN.
Hospital for 25 persons.
SENIOR
ARCHITECT
C
C.p.W-O. , CALCUTTA-
- 72 -
and nearly 700 dispensaries were erected in the areas of refugee
concentrations (see Table 1).
149. The medical c.vJpmjnt contributed by the United Hations system
consisted of a fje?d ?aospital. valued at about §60,500, 1,504 hospital
tents valued at §568.104, 80 barracks and hospital tents valued at
§94,700, and an equipped mobile unit (trailer) valued at §2,970.
0.
LiEDICAL PEBSOIUBL
150. In the early days of the crisis, the Government of India decided, as
a matter of policy, that medical and para-medical personnel for the
refugee assistance programme would be provided by the Central and the
State Governments from their existing medical establishments or arranged
by them from medical colleges.and other institutions.
The presence in
the camps of non-Indian doctors and other medical personnel working
individually or on behalf of voluntary agencies was discouraged.
The
same restriction applied to the United Nations organizations, including
Y/EO.
151 • This decision caused some surprise in international opinion, particularly
among non-government ad organizations, who were keenly aware of the health
hazards which threatened both the refugees and the local population, and
were eager to help with all the-resources at their disposal.
The Indian
authorities based their position on the following reasons:
a)
There were in India a large number of doctors and medical
assistants who were not gainfully employed and could be hired
for the purpose, thus acquiring a valuable field experience.
-1
I
•••
‘b)
73
The cost of travel aM the generally short duration of the
missions made the emplojTcent of foreign personnel uneconomical*
c)
Foreign volunteers were generally not used to work under the
rough conditions of the camps in a tropical climate.
They
would require comfortable accommodation, which would be costly.
d)
Finally, the language barrier:
foreign workers would have to
be assisted by interpreters, which was complicated and
expensive•
52
In practice, some foreign teams did accomplish
Dine specialized fields such as pediatrics
excellent work in
as long as they were allowed to
?ntinue their activity, but the Government’s decision appears to have
ieen, on the whole, well founded, and probably helped to prevent confusion
nd overlapping.
In the course of time, as the pattern of medical
sistance became more or less settled, the Government welcomed the
operation of foreign voluntary agencies and designated camps where they
ried out their programmes
To mention a few instances, Save- the
ildren Fund opened the first children’s hospital in Salt Lake Camp, which
ter became a model for other such facilities set up to cure advanced
otein malnutrition amongst children.
Caritas-India also ran dispensaries
d hospitals for women and children in Salt Lake and ether places in West
ngal.
Among the Indian voluntary agencies, the Rama Krishna Mission and
he Bharat Sevashram Sangh, to name only two, opened dispensaries in a
in* s
in West Bengal
53- Apart from strengthening the regular staff of the State Health Services
n the areas of refugee concentration, which involved the employment of 853
doctors, 142 nurses and midwives, and over 5,000 other workers, and from
*
the work of the voluntary agencies, the Government also found it necessary
to recruit for a short p-w.< jg special medical teams, generally consisting
of a doctor, a nurse and two assistants paid on a daily basis.
The
expenditure incurred to hire these teams was $ 280^000.
The United Nation-i Focal Point provided a contribution in cash of 5250,000
towards this expenditure»
Bo
BEbABKS ON SO?it 0? THS teATN INFECTIOUS BISEaSES
54° Tko iolloving rsmaskn cro only intended to highlight ooeo ©f th
specific health problems which arose amongst the refugee population and
not as an exhaustive report on morbidity.
Table 5 at the end of this
section shows inoculations, number of cases and deaths from some of the
major diseases which affected the refugee population, according to the
records of the Government of India.
A separate sub-section will be
devoted to malnutrition among the children and to the measures taken to
combat it.
a)
Cholera
155. The first cases of cholera were reported among the refugees towards
the end of April 1971 from the Cachar district in Assam.
A/hen these Y/ere
followed in May by similar reports from the districts of Maida, 24 Parganas
and ITadia in West Bengal, it was clear that these were not sporadic cases
and that an epidemic was emerging.
Although cholera is endemic in parts
of the eastern region of India, laboratory tests indicated that the disease
was carried from Bast Bengal by the refugees and load not started in the
camps.
However, in view of the over-crowding,
the poor sanitary
conditions and
rch
flfgl
the state of exhaustion of the refugees after a long
the whole camn population was exposed to the disease.
Local
hospitals and dispensaries treated the early cases, but the local stocks
of anti-cholera vaccine and fluid were soon exhausted.
The Government
of India, therefore, requested the United Nations to airlift anti-cholera
drugs.
The request reached G-eneva on 4 June 1971, snd the first
consignments of 2.5 tons of drugs left Geneva for Delhi on 5 and 6 June.
During the month of June alone, '110 flew to India and placed at the
disposal of the Government over 9 million doses of vaccine, 54,050 litres
of rehydration fluid, 1.5 million injection needles and 70 automatic
"pedojet" injectors.
The air-lift continued unabated from June through
August at the rate of 40 or 50 tons a week, and involved not only anti
cholera equipment and drug's, but other vitally required medical supplies.
In addition to special flights, a number of commercial airlines also
carried supplies free to India on a ’’space available" basis.
The League
of Red Cross Societies and the Indian Red Cross played a major role in
the effort.
156. Anti-cholera vaccination became part of the compulsory process which
refugees had to go through,crossing the border into India, when they were
also given a temporary registration document and a high-calorie ration
to sustain themselves during the journey inland from the border areas to
the camps.
Throughout the duration of the influx, teams of Indian
✓
doctors and nurses worked round the clock with admirable devotion to
carry out this vaccination programme.
In all, nearly 21 million doses
of anti-cholera vaccine were provided through the United Nations system,
- 76 -
. which were used to inoculate both the refugees and the local population in
the surrounding areas.
y
157* According to statistics computed by the Government of India, there
were 49?$40 Qeizures of cholera among the refugees, resulting in 6,144
deaths.
As tragic as these figures are, the incidence of the disease
was lower than could have been feared in the circumstances, and the
percentage of fatalities itself was kept exceptionally low.
156. ’What can be regarded in retrospect as the success of the anti-cholera
drive was due to the massive preventive action taken.
The large-scale
immunization programme was made possible by the constant flow of anti
cholera drugs from abroad, covering not only the refugees but the local
population livin
within a five-mile radius of the refugee camps.
The
use of the "pedojet” injectors in the inoculation campaigns was a
revolutionary novelty which enabled the teams to cover all the vulnerable
groups in time.
Simultaneously, a sanitation and cleanliness drive was
launched in all the camps by the health authorities, as well as by the
Indian Red Cross and the various Indian and foreign voluntary agencies.
b)
Smallpox
159• 2wo outbreaks of smallpox were reported among the refugees, the first
one towards the end of April 1971 > and the second one in January 1972.
160o In the first outbreak in Jest Bengal, 764 cases were reported, of
whom 592 died.
Some 200 cases were reported in other states, apparently
none of them fatal.
The states in the eastern region were asked to
undertake a mass vaccination progra ne in the course of which 5*1 million
Illi
persons were vaccinated and the disease was kept in check.
77
161. The second outbreak was reported from the Salt Lake Camp near
Calcutta, in the last week of January 1972.
close watch.
The situation was kept under
Mass vaccination was undertaken.
Vaccination squads were
posted at the exit points from the camps to ensure that nobody left the
camp unvaccinated and no refugee was allowed to leave the camp and return
to Bangladesh before 10 days from the date of the vaccination.
The
situation quickly became normal again.
KJJ2WHITI0N
162 o in a population of displaced persons already exceptionally exposed
to various diseases, children are a particularly vulnerable group.
Apart from the hazards of living in an unhealthy environment and under
poor shelter, calorie deficiency affects them more than it does adults
•••]
Furthermore the only attention many refugee children received was from
their mothers, whose affection could not make up for their ignorance of
the symptoms of disease and of the action to be taken
163. The daily ratiorulaid do\/n by the Government of India for children
below 8 years of age provided in principle for a calorie content* of just
over 1,000, with 26 grammes of proteins.
However, a high incidence of
severe forms of protein-calorie malnutrition was observed amongst the
refugee children by the UNICJF staff in June 1971*
»
This was confirmed
in July by a team from the All India Institute of Medical Sciences, New
Delhi, consisting of Dr. V. Iteiaalingaswami, its Director, and Dr. B. N
liTl|
Tandon, who had been commissioned
by the Government of India to report on
the state of nutribion and health of refugee children.
UKIC3F reports
78
described many of the malnutrition cases as fitting the description of
the late stages of Kwashiorkor.
-3.64 •The team visited six districts of West Bengal for nine days and
assessed by anthropometric measurements and clinical examination 800
infants and children below 5 years of age.
According to its report,
nearly 50/° of the infants and pre-school children examined suffered from
more or less severe degrees of protein malnutrition.
The authors Yiere
careful to point out that these findings, based on a small sampling, might
not reflect the actual incidence of malnutrition among the refugee population
as a whole $
nevertheless, the report said, the results provided a rough
approximation of the magnitude of the problem.
From their observations,
the team gathered the impression that many of the children did not receive
the quantity of food provided for them in the ration
distribution of food v/ithin
This uneven
family was further borne out by the general
good state of health of adult males, compared to the poor health of infants
and children.
The situation was made worse by poor environmental
sanitation, which exposed the children to repeated gastro-intestinal
infections, and by the common practice among
IMS
Bengali families to withhold
all solid food from a child sick with fever or diarrhoea, and to feed him
only on "sago" (a local tapioca) and barley water
1&5* In these circumstances, any acute infection could prove .fatal* and
the current treatment of the infection itself was
team therefore suggested the launching of
The
^merp'ency supplementary feeding
operation for an estimated 380,000 infants.-and pra-sehoolL children who, to
quote from the report, were "'at the edge cof ta
speaking".
nutritionally
•♦
79
166. The action suggested was two-fold, "both steps having to be taken
simultaneously:
i)
establishment of large-scale mil?., .feeding centres to protect
those children who were suffering from early stages of
nutritional deprivation from more serious forms of malnutrition;
ii)
establishment of nutrition?,! therapy centres as a life-saving
operation for children under 5 years who exhibited signs of
moderate and severe protein — calorie malnutrition.
16?. The establishment of nutritional therapy centres, although conceived
as an independent operation for seriously sick children, was to be closely
related to the establishment of the supplementary feeding centres where,
apart from milk, such protein-rich foods as Balahar (wheat flour, peanut
flour, chick-pea flour), CSLI (Corn mixture of Soya Kilk), and WSB
(mixture of Wheat and Soya beans) could be distributed,.
168. These recommendations were considered by a specially constituted
Technical Working Group at the end of July and the beginning of August
1971, and led to the formulation of detailed plans v/hich were submitted
for approval to the Government of India.
The Government accepted the
proposals of the Technical Working Group and on 9 September requested the
United Nations Focal Point to make available the necessary funds.
Focal Point had, in anticipation already placed
The
million at the
disposal of UNICiU? for the purpose.
Kass Supplementary Feeding.
I69. Supplementary feeding schemes had been a feature of the relief
*
programme since its inception and children and lactating lire thers were given
80 -
milk powder as an additional item of ration.
In addition, the Indian
Red Cross and the voluntary agencies also issued milk povzder to these
vulnerable categories of refugees.
As mentioned in Section II (Food),
the Government had in fact included milk powder and children’s food in
its first requests.
However, these operations remained very limited, and
covered only a small minority of the vulnerable groups.
On the basis
of the recommendations of the Technical Working Group, the Government of
India approved the setting up of 1,000 feeding centres, to cover about
two million beneficiaries, i.o. all children under 5 years of age, part of
the children
.tween 5 to 8 years of age and pregnant and lactating
mothers, who needed a high protein diet in addition to their normal ration.
17^- An important feature of the scheme was that all the wherewithal,
i.e. food and ocher supplies-; as well as the equipment for the reconstitution
and preparation of milk, store:/? facilities, record ca^ds, trails port at ion,
and funds for staff salaries, -/ere to be provided in a complete package, so
as to avoid break-downs which could have resulted from the lack of any of
the essential ingredients of the operation.
171. The overall responsibility for implementing the scheme was entrusted
to the Indian Red Cross end, where it yzas unable to take up this work, to
the local camp authorities.
The Indian Red Cross office in Calcutta
undertook this programme in consultation with various voluntary agencies
and a Coordinating Committee earmarked camps ior various agencies to run
the feeding centres.
At the peak of this coordinated programme al ire. st
1,000 supplementary feeding centres were being run in the camps.
accordance with a detailed plan of operations prepared by UNICJ2F,
In
81
w
an amount of approximately $ 187,000 was provided, as an
• advance
to the Indian Red Cross in October to meet cash expenditures
The League of Red Cross Societies had financed a sizeable part of the cash
expenditures involved.
1720 As the refugees started to return home, feeding centres were closed
down.
Consequently there was a surplus of protein-enriched food (CSM,
WSB) and of milk powder.
After consultations with the Government of
India and the donors, it was decided that the bulk of such surplus stocks
would be transferred to Bangladesh.
A part of the stocks was also diverted
to Orissa for distribution among the victims of the cyclone there.
About
6,000 tons of these supplies has been transferred to Bangladesh and over
5,000 tons to Orissa by 50 April 1972.
Nutritional Therapy Centres;
173« Whereas a supplementary lauding programme, even though on a limited
Hill
scale, was in operation from the very beginning, the medical treatment of
children suffering from advanced protein malnutrition posed entirely new
problems.
The conclusions and recommendations of the Technical Jerking
Croup would have to be tested in the field and would be subject to
modifications in the light of experience.
174• The Group prepared a detailed plan of operations which included a
•111
suggested layout of the proposed therapy centres, listed the equipment
required, and recommended several alternative-recipes for ready-mix hi$
Illi
protein feeds.
inn
It also recommended
that 500 nutrition therapy centres
be opened, each centre to take care of over 200 children.
The children
were to be given four feeds a day of a specially prepared high protein
- 82 -
diet under the supervision of medical and para-mcdical staff at the centre
*
itselfe
The diet finally agreed upon consisted of Calcium Caseinate,
Skim Milk Powder and Castor Sugar, which came to be known as K-Mix-2, and
was prepared in Aligarh, Uttar Pradesh, and sent to the refugee camps.
Bach group of 15 centres was to be supervised by a doctor (physician,
pediatrician or nutritionist).
From the
million made available to
UrTICBF and previously mentioned, an advance of $ 217?OCO was
made to the Department of Rehabilitation on 4 November to cover the cost
of the scheme till 31 December.
175-
It was decided that the centres would be established according to a
phased programme, the first phase to begin with 100 centres, so that the
experience gained could be used in setting up the other centres.
However,
the implementation of the plan was overtaken by the hostilities, followed
by the mass repatriation of th
refugees, and eventual!/ only 88 centres
were established.
17&* The work was reviewed by the All-India Institute of Medical Science
in December.
The report took note of a remarkable improvement in the
health of the children treated, who showed a significant weight gain.
The
incidence of acute infections (diarrhoea, upper respiratory diseases) had
been reduced.
ire
Mortality fell to a very low 1> of the cases, and that
stly during the first
fevz days of activity of the centres.
An important
finding was the effectiveness and acceptability of K-Ilix-2, which caused
a marked improvement even by the end of the first week of treatment.
nutritional therapy centres and
The
have proved to be important breakthroughs*
Their effectiveness was so widely accepted that the Government of India is
planning to introduce the technique as part of its regular health prograj es.
Hill
—
1
OVERALL
u~3
■
■
■
■* 11
RENDITURE INCURRED TCWARDS THE PROVISION
SECTION I.V Health
Table 1 .
OF HEALTH SERVICE
(Source s Government of India)
Numb®'? of Staff
Number of Medical Units
State
West Bengal
Hospitals
Dispensaries
Doctors
1,000
additional
beds in
25 existing
hospitals
500
570
Staff nurses
Midwives
9
9
9
Other para
medical and
clerical staff
1,550
Ancillary Total
staff
•••
2,120
Total
Exnenditure
incurred
(in US 8)
6,466,667
I
CO
vrt
•99
• 99
54
Meghalaya
25O beds
37
Tripura
100 beds
Central camps
in other states
Total
Assam
99
395
•••
449
413,333
69
70
136
71
346
666,666
123
126
32
399
134
691
1,400,000
575 beds
19
34
40
69
319
462
880,000
1,725 beds
679
853
142
2,549
524
4,068
9,826,666
•
A
Notes:
(a) Conversion into dollars done at the official UN rate of Si = Rs 7*5, valid in 1971*
(b) The total expenditure incurred includes the cost of medicines and medical equipments
received from
•Ju
abroad•
(c) The above figures are provisional.
(a) The totals are partial, since some data from Vest Bengal and Assam are missing.
1
SECTION IV HEALTH
TABLE 3
Contributions towards Health Services
through the United Nations System
(valued in US
Purchased
from
Cash
Received
in
Kind
Total
1) Basic Medical Equipment
1 Field hospital
40 Marquees
57 Hospital tents
1,804 Hospital tents
1 Mobile Unit (trai.-er)
60,286.00
50,957.00
20,000.00
611,718.00
2,970.00
60,286.00
50,957.00
20,000.00
611,718.00
2,970.00
-) Medicines and Medical Sullies
a) Provided or purchased
abroad
b) Purchased by G.O.I.
2,910,251.00
500,000.00
466,094.00
5,576,545.00
500,000.00
5) Medical Personnel
Towards costs of medical
teams employed by G.O.I.
250,000.00
250,000.00
1
To tai
4,166,182.00
486,094.00
4,652,276.00
SECTION IV: HEALTH
Table 3
INCIDENCE OF MAJOR DISEASES AMONGST THE REFUGEE POPULATION
AND INOCULATION CAMPAIGNS
(1 April 1971 to JI March 1972)
(Source:
CHOLERA
|
iWv Bengal
Government of India)
SMALLPOX
DIPHTHERIA
Inoculations Cases Deaths
Inoculations Cases Deaths
Inoculations Cases Deaths
5,387,574
5,404,053
49,840
6,144
764
249,000
249,000
[Meghalaya
548,780
545,984
Tripura
1,256,628
850,557
257,682
257,682
50
5,105,056
958
TOTAL
otet
(a)
7,699,464
49,840
Provisional figures
6,144
6,982
524
iOT
•M*
(Assam
efleniral Camps
jin Madhya
[Pradesh, Bihar
land Uttar
Pradesh
592
50
Scabies
(cases)
Respiratory
Diseases
(cases)
176,828
78,186
•Ml
1,154
584
144
18,452
442
150
592
25,564
766
116
•**
MM
MM
22,000
2,500
146
198,823
82,024
I
bb
Contributipns in cash,and kind
through the United Nations system
HEALTH
for Ma3s Supplementary Feeding and
Table 4.
Section Tf
Nutrittonal Therapy Centres.
Alpha
Item
(1000 centres)
Beta
(88 Centres)
Total
(in US ?,)
Contributions in kind
a)
iWF
I
b)
1
Equipment:
Utensils for milk preparation and
distribution, lanterns, furniture,
but excluding hospital-size tents
accounted for under Health.
Supplies:
99,492
165,492
264,984
3,657,766
1,179,046
4,356,812
Mainly protein enriched food; CHM,
WBS, Balabar, in therapy centres,
"K-mix-II"
Contributions in cash
a)
b)
405,600
To the Indian Red Cross for cash
expenditures
186,66?
To the Government of India
Total:
Notes:
(a)
- I
3,943,925
1,561,471
5,505,396
Conversion into US dollars done at the official United Nations rate
of 51 =
(b)
216,933
Rs 7.5, valid in 1971.
In agreement with the Government of India, substantial quantities of
GSM and MBS were diverted to Bangladesh after the return of the
refugees»
(c)
Provisional figures.
- 118
SECTION VII
General Statistics
TAELE I
Refugee population by State
Subdivided between refugees in camp arid out of camp
on 1 December 1971
(source
Government of India)
i
Number of Reiup.’ees
J
r
...... ....
Number of
c am z s
Livinn in
camps
••
Livrn • . vita
friends and
relatives
Total
west Bengal
49 2
4,649,736
2,386,130
7,235,916
Tripura
2?6
354,093
547,551
1,361,649
Meghalaya
17
591,520
76,466
667,986
Assam
28
255/42
91,915
547,555
Bihar
8
56,752
36,752
Madhya Pradesh
5
219,293
219,298
Uttar Pradesh
1
10,169
10,169
S tate
TOTAL
S25
6,797,245
_______________ J__________ _____
3,102,060
9,^99,305
—
SECTION vn
119 -
General
Statistics
TABLE 2
Statements of Lypencirure on heljef to Rei'igees from Bangladesh
(Sourceo’
Government '.f India)
Indian Rs
(Ip PP .1] A *2J1D
( in n>il?.ions)
1,346.2
179.76
579-7
0.4
77.29
62.5
71.0
8.55
Basic Food Rations, Value of other
items in cosh or kind including
daily cash allowance
Shelter
Beddings
Vater svply and sanitation
Vehicles
5
Transport charges
(r umning expoas es)
50.0
9 • 47
4.00
Blankets
Utensils
>6.0
4.80
14-3
Clothing
45.2
1.91
5.76
Medicines
75.7
9.85
Baby foc-d. milk powderf CSM/kSB,
tinned stufis and other food items
150.0
20.00
Operation Life Line
26.7
5.56
Repatriation expenses
409.5
54.57
Miscellaneous (including administrative
expenses;
1S5.4
24.72
—1
•
404-05
Outstanding liabilities
3,050.4
200.0
5,250.4
Notes:
26 c 67
45042
a) Provisional figures.
b) Conversion into US
at the official UN rate of
US $1 = I.Rs* 7-5, valid in 1971*
SECTION VII
- 120 -
Table 5
STATUSw 0? CCJTHITU'TIOrS
THE UN SYSTEM*•
MwMM*
i ———i M»■' ■-THROUGH
■»■«» ■*——M—
SITUATION AS OF 21 JUNE J 972
■■H
IN
US
DOLLARS
■
'
■
--------------------- ----------------------- 1
1
PLED G E D
DONOR G0VER1WTTS
(i
3
r-i
Ox
rH
-•
r— 1
<
-0
o
C\
C
M
- ■
Irgertir.a
Australia
595,521,68
Austria
164,789-58
Barbados
2,500.00
1.082,110,00
Belgium
Botswana
8,555.55
Braz^^
Canada & Provinces
4,806,950.69
Ceylon
Chile
5;0C0.00
Colombia
Cyprus
11,999->04
4,680,693.6?
Denmark
5,968.23
Dahomey
5,000,00
Fiji
Finland
5'77,785 ..09
France
255coo
Gambia
Germany (FedoPcp.)(2) 17.471,026.25
25,009.80
Ghana
Guinea
2,500.00
Guyana
5,000 0 00
Holy See
Iceland
8,594.79
••
Iran
154,852.42
Irel^ad
25,828.97
Ita'W
12,745.10
Jamaica
Japan
27,678.22
Kenya
1,000.00
Khmer Republic
60,000.00
Kuwait
50,000.00
Liberia
200,204.15
Libya
Liechtenstein
10,037.77
Luxembourg
. 15,957.45
27,099.60
IVialaysia
1,869.16
Mauritius
Monaco
5,454.78
1
RECEIVED
TOTAL
CO-00
2,355,666.36
501,293-48
99,789.58
164,789-58
2,500.00
2,500.00
i
l,082;110.00
1,144,663 .19
62,555.19
8,535.33
8,355.-55
37,204e25
17,204.25
8,903,861.58
4,806,950.69
4,096,950.69
336.134.45
556,134.45
5,000.00
5,000.00
5, COO-00
5,000.00
11,999.04
11;999.04
4,680,893.62
4,680,893.62
5,968.25
3,968.25
5.COO.00
5,GOO0CO
577,785.09
577,785 ..09
2,908,114.91
2,90-8,114.91
255cOO
255.00
20c:coo.00 17,671,226,25 17,471,226.25
25,009,80
255009-80
20,000.00
20,000.00
2,500.00
7,680.00
5,180.00
5,000.00
5,000,>00
'
8,594.79
8,594.79
185,606.5^
183,606.56 i
254,842.82
119,990.40
154,852.42
23,828.97
;
23,828.97
12,745.10
■
12,745.10
4.891,700.00 ! 4,891>7OO.CO
27,678.22
I
27,678.22
«■<
[
1,000.00
60,000.00
i
60,000.00 i
50,000.00
50,000.00 •
200.204^15
200.204.15
10,037.77
10,037.77
15,957.45
15,957«45
MM
27,099.60
27,099.60
1,869.16
50,CC0.00
51,869.16
5,454.78
5,434.78
____________
00.00
1,760.145.18
MM
r»
0
MW
0
►M
♦
MM
MM
M»
V
OTM
*M
The original pledge from Argentina (4,000 metric tons
of wheat) has been transferred to UNRCD, Dacca.
(2)’ Not including DM7,200,000 (US 52,168,674.70) utilized
'■
CASH
1
1
KIND
CASH
(1)
■■
by German voluntary agencies in Bangladesh.
>
••-.
:
*
;i- - .
r
;
0
- 121
•
-.0
Q j
•
. r~ l
(
e
•
■
>
1
PLEDGED
dc:;c2
- - .****■“•
KZ2D
--- —
v.SN
J
___ —------Nepal
"
’
r.150.98
Netherlands
1,532;512.59
*«
iiew Zealand
”;i%ro.79
Nigeria
"C 00c.co
M.
Norway
: S--ls.%.96
Oran (Sultarax- c.•-' ■- >.
Peru
184,898.15
MB
San Marino
' .<02.56
f
*S ine -‘al
Singapore
LZ.l-r7-Co
Spain
42,857.00
•••
Swaziland.
1.199.90
M>«
Sweden
r
,856.05
S^ktn er land
2.-50,665.29
•<
!•—zania (United B.?.. Z'.
3,405.36
Thailand
’ ;
24,800., GO
Togo
1,16".51
WI
Tonga
282< 61
MB
Trinidad
re car 7
10.C53e44
Uganda
!
2’,CC5.6O
United Kr-rdac
: 2 ?.or 5;411.96
United Stages
46,425,000.00
<5 2.010.00
Uruguay
f
« k/v
'•B
Vietnam (Ren. of
—. y
• QC
Yugoslavia
20,000.00
BWB
Zambia
le.005.56
Sov. Order of Ihlrr ‘
BOB
10,801.26
1
. x;,;- •>
fm
•■B
. SUB TOTAL
| 11^,675.741.56
■P-, _ - - - - T .-*-•
■ »■■ .1 w ——f NON CxOVrTUUlY^Al
QF.C-;ri:lY?irNS:
Australia
j
438,764.75
f^Tivn
1:5.£05.19
CctllcLClCt
97,212.01
Cyprus
i
78J.5O
France
x • 1,1’0,,06.66
Germany (Fed.hep-; . -,553,607.66
*
Guyana
‘
Ireland
«
1 159.50
Israel . ‘
'
1,226,19
E<9 61
Italy .
'
■ ■
(5)
■
■ >
1
CASH
TOTAL
received
2;45O.9S
5,755.630.71
115,170.79
70,009.00
3,781,804.96
25,000.00
184,898.15
1,602.5c
7,194.24
13,147.03
42,857-00
1,199-90
9,559,836.05
2?258,665-29
6,403.36
24-800,00
1,167.3]
282.61
10,058c44
14,005.60
25,863-411.98
82,175,000.00
2,COC,CO
15,000 <.00
20,000.00
28,003.36
10,801.28
2,450.98
4,423,318.12
115,170.79
70,000.00
5,781,304b96
25,000e00
59,776,312.44 174,653,054.00
1,602.56
7,194.24
13,147.08
1,199.90
9,559,836.05
2,258,665.29
8,403.36
«
1,167.31
282.61
10,058.44
14 y005•60
25,865,411.98
35,444,887.30
•M
15,000.00
A
10,801.28
114,381,397.30
■■
%
76.822.30
13,285.53
MB
MB
2,500.00
575, 5 37,.05
119,088.72
97,232.01
763-30
1,13G,CO6.66
1.535,607.66
z, 2,500.00
1,199.60
1,226.19
849.61
Not including
10,232,000 i.c. the value of .metric
• '..tons 40»CX.\> sr..tre .e..ea CSl^/VTsb sent directly to Bangladesh.
453,764,75
105,805.19
97,212.01
703.30
1,130,006.66
1,535,607.66
•
1,199.60
1,226.19
849•61
SECTION VII
Table 5
- 122 -
i ——■
-- T____ , ,
. „ ..
PLEDGED
CASH
DONOR
CASH
KIND
TOTAL
RECEIVED
53,454.54
1,004.98
1,592,722.27
143,082.29
155,996.92
124,740^12
13,120.84
504,522.26
5/< 20,097.19
NON GOVERNZH'NTAD
ORGANIZATIONS cont,:
Japan
Luxembourg
Netherlands
New Zealand
Norway
Sweden
United Kingdom
United State*.
55,454.54
1;004.98
1,592,722.27
143x082.29
153,996=92
124,740.12
15,120.84
304,522.26
MB
50,374.00
MB
•W
49,504<95
117,063.57
1,004.9S
1,592,722.27
175,456.29
153,996.92
124,740.12
62,625.79
304,522.26
O SUB TOTAL
5.720,097.19
254,095.81
5>?!>!-,193c 00
235,116.90
235,116.90
9-730.00
1,463.02
29,740.69
•-4
•M
<• •
9,730 00
1,465.02
29,740.69
9,750.00
1,465.02
29,740.69
SUB TOTAL
40,953.71
255,116,90
276,050-.61
40,955 71
PRIVATE DONORS:
Canada
Malaysia
Switzerland
United States
Zaire
Other countries
1,365.25
1,308=26
2,518.59
20,985.31
13,539.72
3,707.98
•**
1,885.23
1,308.26
2?518c59
20,986.34
13,559.72
3,707-98
1,865.23
1,508.26
2,518.59
20,986.54
15,559.72
5,707.98
45,946.12
45,946.12
500,000 ..,00
600,000.00
166,540.00
2,782,111.00
500,000.00
4,0-48,651.00
500,000.00
63,794,176.15 183,270,514.74
118,580,994.3:
OTHER DONORS:
- Air Companies
- Gift Coupon Progr •
UNESCO
— I. C.M T.U.
- UN Staff Ass.
SUB TOTAL
43,946.12
61,609.03
•<
•B4
aaa»
"■ ■ ■
-
TIN AGENCIES:
-
UNHCR
UNICES'
wo
7?FP
500,000.00'
■t
600,000.00
166,540.00
2,782,111.00
SUB TOTAL
500,000.00
3,548,651.00
GRAND TOTAL (4)
(4)
m
BB
119,476,338.59
Ml
After substraotion of US $ 1,705,379*99, as certain
contributions transited through mere than one donor.
e
•
•
- 12? PLEDGES
IN KIND THROUGH, 7<r; UN
21
DONOR
JUNE
SECTION VII
GENERAL STATISTICS
SYSTEM
Table a
1°72
j'CSC.HPf ICTf
CUiJ?.?ITY
V.xLUE IN
Ub 5
9;775 3t
5,111 mt
5 flights
10.5 mt
1,135,012.84
625,132.34
62,555.19
17,204.23
24,8^ mt
10 flights
5,715,346.53
232,574.26
GOVERl^TS:
Aus oralia
Belgium
Brazil
Canada:
- Government
- Government
- Province of
Saskatchewan
.on
Colombia
Germany (Fed»Rep«)
Guinea
Guyana
Iran
Ireland
Japan
•
I
I
I
I
Rice
Sugar
Air transport
Hi Ik uovrder
9
••
Rapeseed
Air transport
I
I
I
I
I
I
I
Peru
Spain
Thailand
UnTted States
SUB TOTAL
I
«
%
Lieuritius
Netherlands
Yugoslavia
«
*
I
Rapeseed
Clothing
I
Sugar
Skim mi.lk powder
Small pox vaccine
Rice
Cholera vaccines
»
Skim milk powder
;
Rice
j
Skim milk powder
Suffer
Dried skim milk
Canned fish
j
Biscuits
j
Peas
;i
•
Sugar
Under negotiation
Rice
|
Uedical supplies
j
Rice
;
Su.gar
■
Rice
Soy fortified bulgur
Vegetable oil
Food through voluntary
agenciesc
?:>B/ 05: ■. unsweet ened
Tents
*
642 mt
250,000 saron. s
15 mt
JOO art
2 million units
37 mt
1 million doses
227 mu
27?580 mt
1,110 mt
502 mt
272 mt
100 mt
870 me
2,590 mt
2,000 mt
*•
1,000 mt
•••
200 mt
10 mt
9c,<-52 mt
4 ; • r8> mt
50,852 mt
1>,/’0b mt
37 units
99,009.90
'336,134.45
I
3,coo.00
200,000.00
20,000.00
5,180.00
183,606.56
I
li9.990.40
3,8$l,700.00
1,000,000.00
50,000.00
192,695.22
59,059.55
252,116.53
4 zp!, 416.5 2
354,948.46
29,096.51
184,893.15
|
42,857.00
i
23,000.00
|
1,800.00
13,505,000.00
935,000.00
15,950,000.00
6,920,000.00
4,315,000.00
20,000.00
59,776,512.44
- 124 -
_____ ._____
DONOR
7ALUJ IN
US :J
DACORIPTIO1T
¥
1
OTHJR DONORS:
a a»*aa«9
Australia
Belgium
Guyana
Japan
'.Tew Zealand
United Kingdom
irj^Corpanies
21,500 units
5,25C uni'sc
1,600 units
20 nt
7.5 Ht
11.0 mt
ICO canes
Blankets
Blankets (Red Cmsr--}
Blankets (Sscours Adven.)
Rice
kill: nowder
Baby food
L-edical supplies
•Role milk bxrcults
Acriflavin
lulti vitamin tablets
' edical supplies
ClothiniSr freight
•
<
V
•
«
•
•••
200,000 unite
113.1 nit
K.
!
i
'
'
I
76,822.50
10,658.30
2,647.23
2,500.00
6,000.00
23,761.90
31,847.15
2?,131.CO
112.00
1,019.00
112.00
49,504.95
235,116.90
■
;
j
:
:
'
'
'
i
I
SUB TOTAL
69,212.71
s
I
•
I
U:
Mi I i *i ■AG INCUS
I .!■ •"• g
UlTICRF
WHO
UTP
.
I
■* ■» • «—• *• ■ I
I
A'q1 v.ipment and sup 1:lies
redical svnnlles
iiilk powder
Zdible oil
Pulses
:
WWW
5/329 irt
1,548 nt
19; n.t
■
1
:
600,GOO.00
166,540,00
1,371,149.00
852,981.00
57,981.00
’
?
1
•’
SUB TOTAL
i 5,548,651.00 ;
1I — M —* —«—■
« V • • 1I•
GivuCD TOTaL
; 65,7%,176.15
125
SECTION Vil - General Statistics
Fable 5
G? ASSISTANCE FROM AUB THROUGH TEE
;r< pvsiEM AS CI< 51 HaY 1972
•
Million
T]JU.S,
O v:
Million
use
-;•:
) 1
zi
»
•
(b cl
0
* •
. • : ’•0 (
U )
■
« •;
(j r.
i;
G
>
•’ ’i
•ij
J y
0
n<
60 2Ja
1
i
1
Delivers 1 in .<inl cr
processes for delivery to
India» iaclvciru; value of
overs ear. tr ar.c nor r =. t i or.
39-52
153.81
Contn tu’i-ie m rash and
kind earc^rk-. 1 for, or raid
by dano r jo rr.oer. ts, to
vo Luntxr*.
er. 0•:
14.50
Cash uro nr rroceas cl final
allocati; . Pi.i c.ac-h z-ooelvable
7.07
Funds set aside for
admini e ora tn v e e:- r enc.i our e
and contin^Ten jies
1,89
'■
Io tai
1
Note:
a;
•
of vhich v.6.5 million tor transfer 'to Bangladesh
183.27
URGENT
SUMMARY REPORT ON THE STATE OF NUTRITION
AND HEALTH OF INFANTS AND PRESCHOOL
CHILDREN AMONG REFUGEES FROM
EAST PAKISTAN
By
B»N* Tandon
and V< Ramalingaswami
All India Institute of Medical Sciences
New Delhi.
MESSAGE OF THE REPORT
The state of nutrition of infants and pre
school children among the refugees is serious
Urgent remedial action is needed.
24th July 1971
1.
In 9 continuous days from the 14th to the
22nd of July, 1971? we studied the state of nut
rition and health of infants and preschool
children among refugees from East Pakistan in
6 districts of West Bengal through rapid methods
of assessment.
13 camps were visited in these
six districts and 800 infants and preschool
children were assessed for prevalence of mal
nutrition by anthropometric measurements and
Rapid impressionistic surveys
clinical criteria.
of nutrition and health in the camps in general
9
were made involving a larger number of refugees,
2. General Backgrounds A massive and highly
impressive relief operation has been mounted.
A vast network of camps totalling 1150 in number
have been established.
fixed.
Some are transitory, others
They are dotted all over the countryside
in the districts bordering East Pakistan - in
open fields, by the road side, along tank bunds,
in temporary buildings and even under the cover
of big banyan trees.
Regrouping of camps is going
on from time to time and the whole picture is in
a state of flux.
More evacuees are still arriving.
Although there is much overcrowding, majority
have some kind of shelter,
A remarkably successful operation for the
distribution of food rations has been organised.
Every family gets a card for rations according
to a prescribed scale and rations are distributed
weekly.
A large-scale operation for the control
of cholera has been launched^
Judging by the
massive scale by which the influx of refugees
took place bringing with them strains of cholera
vibrio which are not now endemic in West Bengal,
a halocaust could have taken place,
But cholera
has been tamed and the millions of Calcutta
Cholera and gastro enteritis treating
saved.
centres have used the results of recent researches
on cholera.
30 lakhs of refugees out of 3^- in
West Bengal alone have been inocculated against
cholera*
Although the death rates from cholera
attacks vary considerably, they have generally
been reasonably low.
Smallpox has not shown up
on any significant scale.
20 lakhs of refugees
have been vaccinated against smallpox in the
West Bengal sector alone.
Other diseases such as
infectious hepatitis and typhoid fever have not
shown up as major problems.
Conjunctivitis,
measles and chickenpox have broken out in some
camps.
Measures for the improvement of environmental
sanitation can never be adequate in a catastrophe
of this magnitude.
Nevertheless, an impressive
set of measures has been taken in the form of
sinking of tubewells, disinfection of water sources
and anti-malarial measures.
At this time of the
year, in rural West Bengal with the heavy monsoon
showers, there is so much stagnant water all
around that pollution of environmental waters
presents great many difficulties for control.
3• Nutrition of Infants and Children:
The
major nutritional problem of infants and children
was Protein Calorie Malnutrition*
Nearly 50 per cent
1
- -fr «
3
of the infants and preschool children studied
fell into the categories of either moderate or
severe degrees of protein calorie malnutrition.
Diarrhoea, obviously related to the state of
environmental sanitation and lowered resistance
to infection, is a nearly universal accompaniment
of malnutrition.
Even minor infections would
tip the scales in such deprived children and
unless urgent remedial measures are taken,
substantial loss of infant and child population
may occur quite apart from developmental retar
dation that is bound to afflict this group widely.
We were informed that by the 10th of July
1971, 6.7 million refugees have crossed over from
East Pakistan, of which 5*1 millions have crossed
into West Bengal alone.
There are believed to
be 1.1 million children below the age of 8 years
in this population and 0.3 million lactating
mothers.
It is possible that children below
5 years would be approximately 0.6 millions
(6 lakhs) in numbers.
Our finding that 50 per cent of children
below 5 years of age show moderately severe and
advanced stages of Protein-Calorie Malnutrition
in a study of 800 children in this age group in
the 6 districts of West Bengal may not be applicable
to the actual prevalence of these forms of
malnutrition in the refugee population as a whole.
Our sample is very small and not representative5
nevertheless, we believe that the results
provide a rough approximation of the magnitude
of the problem.
Undoubtedly there are camps
where the picture is a good deal worse and others
better.
We estimate that 0.3 million. (3 lakhs) of
infants and preschool children under 5 years of
age may be suffering from moderately severe and
extreme forms of malnutrition among the entire
refugee population.
Their rehabilitation is a
matter of great urgency as any acute infection
can prove fatal in a majority of them.
Current
efforts of treating the infection alone cannot
save the lives of these children.
4. Food: Every person above the age of 8 gets
the following ration per day, those below 8 years
of age get one-half of this ration.
Protein
content
(Gm)
30 gm.
Ration
Calorie
content
Rice
400 gms
(whi t e)
1392
Pulses 100 gms.
(Bengal gram dal)
372
20.8 gms.
Vegetables 300gms.
240
(Potato and onion)
3:1
Oil
250gms/week/family
3
3.0 gms.
Total/adult
unit
2036
53*0 gms.
This provision would provide approximately
2000 calories and 53 gips. of protein of vegetable
origin derived from rice and pulses mainly.
While it does not fulfill all the nutrient needs
of an adult, it goes a long way towards meeting
them with particular reference to calories and
proteins.
Any child under the age of 8 is provided
with one-half of this quantity
Thus, theoretically
5
each child under 5 gets approximately 1000 calories
and 27 gms. of protein.
Despite this, however,
there is wide prevalence of severe forms of protein
calorie malnutrition among the refugee children.
The impression we gather from observing a number
of children in the camps is that many of them do
not receive the quantities of food provided for
them in the ration.
This, coupled wi th the state of
environmental sanitation which exposes them to
repeated gastrointestinal infections, aggravates
the situation.
Furthermore, it is a common
practice among the refugee families, as it is
in the rest of India, that whenever a child falls
sick with fever or diarrhoea, all solid food is
withheld and ’sago' and barley water are given.
Indeed we have come across instances where the
regular rations have been sold in order to buy
sago or barley for feeding sick children.
This
can only make the already bad nutritional situation
worse.
That there is an uneven distribution
of food within the family is further borne out
by the fact that while the state of health and
physique of adult males in many of the camps is
in general quite good, that of their infants and
children is serious.
5• Remedial Measures:
Nutritional Therapy Centres and Large-scale
Milk Feeding Centres:
The enormous numbers
of infants and preschool children estimated at
3 lakhs that are at the edge of a precipice,
nutritionally speaking, calls for an emergency
relief operation of supplementary feeding with
proteins and calories.
Time is of the essence.
do not think that increasing the rations would
I
6
make a significant impact on this problem, in the
immediate future/ although, logistically, this
would be a far simpler operation.
The.relative
I
availability of food grains in the huts and tents
alongside extreme hunger and starvation of
infants and children is an indication for rapid
remedial action through 'supplementary feeding.
We recommend that two steps be taken simulta
neously and immediately - 1) Establishment of
Nutritional Therapy Centres for all children under
the age of 5 who exhibit signs of moderate and
severe forms of protein calorie malnutrition as
a life saving operation and 2) Establishment of
large-scale milk feeding centres for all infants
and children under 5 years of age mainly as a
measure for preventing those children who are in
the early stages of nutritional deprivation and
are beginning to falter, from getting into graver
forms of malnutrition.
Children between 1 and 3 years of age are in
most urgent need of nutritional therapy and
rehabilitation.
Highest possible priority should
be given to this group.
Organisational Setup; The general administrative
framework of the districts under the supervision of
the District Magistrate and the health teams under
the District Chief Medical Officer of Health are
doing a splendid job but they are presently
greatly overworked, many are tired and exhausted.
It would be unfair to expect this group to share
the additional burden for the twin activities
proposed here - Nutritional Therapy of seriously
sick children and Mass Feeding of Milk to the notso-sick without giving them additional full-time
I
support 5 and yet it is important that this
nutritional work be closely integrated with the
health effort in the area - medical relief,
environmental sanitation, preventive inocculation
etc.
We suggest the setting up of a Nutritional
Relief Agency for the refugees with a Co-ordinating
and Policy Committee controlling it at the highest
level.
The Committee would have the authority
to direct the relief operation and to sequester
personrdand resources and to make all decisions
relating to the relief effort.
An executive
secretary, a dynamic person preferably a technical
person, could function on behalf of the Committee.
The composition of the Committee may be such as
to provide for a co-ordinated approach by the
Central Government and the State Governments of
West Bengal, Tripura, Meghalaya and Assam.
Representatives of international organisations
that are deeply involved in the relief effort
such as UNICEF, The World Food Programme and
the
Red Cross should be closely associated
with the Committee.
Voluntary agencies which
have a significant role to play in the implemen
tation of the programme should also be connected.
The Committee would serve as a contact point with
all national and international bodies connected
with the relief effort.
It would centralise
resources, localise areas where disaster is
impending and mobilise effort for dealing with
it rapidly.
It would have surveillance teams
which provide an assessment of the nutritional
situation in the camps from time to time.
8
This Committee through its executive
secretary functions in the districts through
District Co-ordination Committees which already
exist on which the District Magistrate and the
Chief Medical Officer of Health and others are
represented.
At the operational level, full-
time personnel would be employed for the prepara
tion of food and on-the-spot feeding and transport
and equipment needed for the operation should be
provided.
It is understood that a plan has been
drawn up recently by the UNICEF in association
with the Red Cross for the feeding of approximately
2 million children below the age of 8 years and
nearly 400,000 lactating mothers through the
establishment of 1000 feeding centres each of
which will feed 2000 beneficiaries.
The foods
for this purpose would come from the Red Cross,
the UNICEF and the World Food Programme.
The
Plan also envisages the commitments that the
Red Cross and UNICEF would undertake in the
implementation of this programme with the
Red Cross as the main executive agency.
While we are in agreement in principle
with this programme and support it entirely, we
believe that this alone where children would be
collected at a feeding centre, would not take
care of children seriously ill with moderate and
advanced forms of protein calorie malnutrition
who lie in the tents and huts and whose feeding
requires individual effort and whose rehabilitation
involves in addition to feeding special foods
other measures for the control of infection end
correction of fluid and electrolyte disturbances.
9
I
0
We, therefore, recommend the establishment of
Nutritional Therapy Centres for the care of these
sick children as an operation by itself but in
close relationships with the milk feeding
programme.
In addition to milk, a number of
other processed foods of proved value may be used
in the Therapy and Feeding Centres - Balahar,
CSM, PKFM etc.
Unless urgent remedial measures are taken
to improve the nutrition of infants and children,
much of the effort already made and the future
effort in preventive inocculations and environ
mental sanitation would be greatly frustrated
for the full benefits of such activities cannot
be realised without a complementary improvement
in the state of nutrition.
Rations:
As an emergency subsistence, the scale
of ration provided meets the bulk of the caloric
and protein needs of adults.
In actual practice,
we observed that in some of the camps we visited,
what is theoretically provided is not fully
distributed.
In all camps 400 gm of cereals are
being given.
In some camps, 100 gm of pulses are
being distributed as in the scale of rations, in
some 50 gm only and in others none at all.
We
urge strongly that all measures should be taken
to see that 100 gm. of pulses should be distri
buted in all camps.
We observed in one camp that in place of
pulses, Kesari Dal was being distributed.
is dangerous and should be suspended.
This
We donft
think, however, that Kesari Dal is being distri
buted on any large scale.
I<
10
The scale of rations provides for 300 gms,
In no camp did we find this
of vegetables.
provision fulfilled.
In some, 100 gm. of potato
is being given; in others none.
Every effort should
be made to provide the full amount of 300 gms. for
this would greatly improve the nutritive value of
the ration.
The countryside of West Bengal abounds
in green leafy vegetables at this time.
All edible
and available green leaves should be utilised to
the extent of 100 gms. a day per adult unit.
The scale of ration provides for oil although
the exact quantity is not specified.
tion is erratic.
Its distribu
We recommend that 5° gms • of oil
be supplied per adult per day.
This would be
welcomed by the population and would confer
nutritional benefits upon them.
In many camps, in lieu of either vegetables,
or oil or salt and condiments, cash is being given.
We realise that this is being done because of non
availability.
We strongly discourage this practice
of provision of cash in place of food materials.
The replacement of rice by wheat flour to
the extent of 100-200 gm. per adult unit per day
should present no problem and we recommend it to
the extent that the exigency of cereal supplies
dictates.
Children between 5 and 8 years of age
suffer quite a marked deficit in their caloric
■
needs under the existing scale of ration.
Stepping
up of the scale to this group from one-half to
two-thirds of the adult scale may be considered.
Two meetings of the Technical Working Group of the Co
ordination Committee was held on Saturday, the 31st July,
at 4.00 P*M. and on Monday the 2nd of August, 1971 at 11.30 A.M.
in the Board Room of the All-India Institute of Medical Sciences.
Prof* V. Ramalingaswami was in the Chair and the following were
pre sent •-
Dr- Raghunath Sahai Chawla
Shri Anupam Dhar (Present only on 31st July)
Shri K.K.N.P. Rao
Mr* H*K« huloy
Mr* W. Keller
Dr. FrJ. Loven
Dr. G.V- Foil
Mr• T . Page
General Moitra (Present only on 31st July)
Col. Bhatia
( ”
”
”
”
)
Mr* Emil Bria ( ”
• ”
”
”
)
Dr.. Banwari Lal
Dr. B-N. Tandon
Dr. L-M. Nath.
*
'
■
Prof. 0-P- Ghai (Present only on 2nd August)
Mrs- P.-Kaushik ( H " ’
n
”
”
)
.
•
The Chairman welcomed the members and appointed Dr. L-M.
Nath as rapporteur. Dr. B.N. Tandon and Shri K- Ram a ch a nd ran ■
presented a draft plan for Nutritional Therapy Centres and
Mass Supplementary Feeding CentresI
I
The plan was designed to deal with the urgent nutritional
problems of infants and preschool children among the refugees as
brought out in the recent study of Drs- Ramalingaswami and Tandon.
Children under 5 years of age suffering from severe forms of
protein-calorie malnutrition (Grade III) needed to be treated and
rehabilitated in Nutritional Therapy Centres. The rest of the
children under 5 years would be given
supplementary feed? on a
mass scale at supplementary Feeding Centres* Children between
5 to 8 years, pregnant' women and lactating mothers would be
supplied along with their ration - supplementary foods.
Highest priority would be given to the treatment of
children under 5 years of age with severe protein-calorie mal
nutrition, whose lives are in peril. Next in order of priority
would be supplementary feeding of the other children under
5 years who are not so sick, Allowed by preventive supplementary
feeding of older children, pregnant women and lactating mothers□
}
The Plan was discussed in detail and as a result, the
proposals attached herewith have emerged.
*• •
The Group urges the Chairman of the Central Co-ordination
Committee to give his urgent consideration to the measures
suggested here.
The Group desired to record their appreciation of the
help and co-operation given by the All-India Institute of Medical
Sciences in focussing attention on the problem and in devising
methods for its amelioration.
-9-
EQUIPMENT PER CENTRE;
Of si 7.0 30’x20’
- 4 to
Hospital tents
12’xl2’
Of si
Small tents
- 5
Degchis
- 4
Buckets
- 10
Stirrers
- 6
- A
Measures
Spoons
- 30
Feeding cups with spouts -100
Plastic sheets
- 30
of si~e 4t1’
Flooring-Tarpaulin
of size 3O’x2ir
- 6
- 2000
Registration Cards
Nasal feeding tubes
■■100
Normal saline
bottles
Glucose saline 5%
bottles
Syringes-5CC
10 (If disposable 50)
Needles Transfusion Sets
Medicines
Kaolin Powder 5 kg.
Sulphadimidine 1000 tabs*
Cut-down sets
1
Small container for boiling(sauce-pan type)
10 bars
Soap
Disinfectant (Dettol)
1 can of 5 litre .
STAFF PER CENTRE-
'Interns
Paramedical Workers
Helpers
Supervisors
Cooks
Sweepers
Washerman
J
2
9
(1+2)
(1+1)
As many of these as possible may be recruited locally.
There will be one Doctor (Physician, Pediatrician or
Nutritionist) for 15 Centres* He will be stationed at the
PHC or SHC and will be provided with a Jeep. A total of about
35 Jeeps wo^ld bo needed*
READY-MIX HIGH PROTEIN FEEDS?
1)
2)
DRY-WEIGHT(GM.) CALORIES PROTEINS'
(GM.)
100
38.0
357
Dried Skimmed Milk*
PKFM.
- ■■ ■ 1
’
Corn meal
Full fat soya flour
Drv. skimmed milk
Sugar
Vanila
3)
4)
100
40
38
D
15
o
BALAHAR?
Whole Whoat flour
Pea-nut flour
Chick-pea flour
100
OS M;
100
cj *f“ O A
*1 /*> -p Cl +• 4-
zl
21*5
*
392
19.0
373
20.0
65
25
10
Processed (nre-cooked)
com meal .
T fh
388
O
rv
T r*
1
-P n
11
64
0/1
5)
WSB*
100
Wheat fractions
Toasted, defatted soy "
flour
Soy oil, stabilised
Vitamins & Minerals
6)
Calcium caseinate
Dry skinmed milk
Sugar (Sucrose)
20.0
352
21.1
73.4
30.0
.0
2.6
100
KM-2S
373
16.5
27.5
55.0
RECIPES FOR NUTRITIONAL THERAPY CENTRES £
Dry skimmed milk
Semolina (suj i)
Butter oil
Sugar
1.
Water added
100 gmSo
100 11
80 ”
175 ”
1750 ml.
Total volume on final preparation- 2050 ml.
2)
•
Food values ofc final preparations Calories* 212 5
Proteins :
48.0 p-m.
Fats
s
8zi .0 gm.
CHO
s 236.0 pm •
*
12 5 gms /
Dry skimmed milk
100 gms.
Corn starch
Butter oil
80 gms
Sugar
15 0 gm s . '
Uster added 2500 ml.
Total volume on final preparation- 2500 ml.
Food values of final preparation - Calories’- 2225
Proteins•
47 . 5 . gm
20-.0 gm
Fats
•
CHO
320.0 em
3) Modified KM-2:
«
*
Use Calcium Caseinate (75 gm.) in place of Dry Skimmed
milk powder (100 gm.) in Recipe (2) above, retaining the other
constituents in the same quantity. Water to be added to be
decided by actual cooking-not done yet.
Food values of final preparation (volume to be worked out)
Calories- 1981
Protein *
47.5 gm.
80.0 gm.
Fats
«
CHO
250.0 gm.
liotel As Balahar and CSM are readily available in sub
stantial quantities, the group recommended that recipes may be
evolved using these with a view to enhancing their caloric
contents. They can then be used in the feeding programmes.
contd
ALT ER NAT IVE NOT R IT 10 NAL_T HERAPY SCHEDULES USING THE ABOVE
3 RECIPES;
Schedule !•
Modified KM-2 for first 10 days followed by Recipe No.(I)
or combination of Recine No.(I) and Recipe No.(2) as alternate
feeds (on the same day) till the patient is fit to join’the
supplementary feeding groups-approximately 6 weeks. The choice
to use Recipe (I) only or both may be decided on the availability
of £prn starch and Semolina (Suji).
The Modified KM-2 schedule has to be worked out in
detail after cooking trials with this mix.
Schedule II*
Use Recipe I only from the beginning ^s detailed below*
Quantity per feed Total Quantity/day Calories/ Pro:teins/
dav
day
____ LulLJ_______________ (d feeds)
Age
800
1000
1200
200
250
300
under 2 yrs .
2-3 yrs.
4-5
-4.
* yrs.
900
1100
1320
•
20
25
30
Schedule IIP
Age
.
Quantity per feed
"• ' (ml •)
Under 2 yrs.
2-3 years
4-5 years
Under 2 yrs.
2-3 years
4-5 vears
-
\2
550
660
770
feeds)
•
503
60)
700
250
300
350
Calories/day
Recipe I Recine II
Age
Quantity/day
450
540
630
Proteins/day
Iota]., Recipe I . Recipe II
Total
1000
1200
1400
22.0
26.4
30.8
12.5
15.0
17.5
9 .5
11.4
13.3
ESTIMATES OF QUANTITIES OF FOOD REQUIRED^.
r<i x
The recent study of Dr. Ram al i ng a swami anr1 Tandon revealed
that of children under 5 years of age, approximately 36% are under
2 years of age, 39% between 2 and 3 years and the remaining 25%
between’4 and 5 years of age
On this basis, it is estimated
that to feed the 1,15,000 infants and children under 5 years,
suffering severe grades of protein-caloric malnutrition, the
following quantities of food.will be required for one, month.
9
(a) Using schedule II -abQve (Recipe (I) only - four fee.d_s. a day) s
Dry skimmer; Milk
Semolina ’Suj i)
Butter Oil
Sugar
168.0
168.0
135.0
394.0
tens
tons
tons
tons
contd.......... 5/-
-3-
5)
WSB>
Wheat fractions
Toasted, defatted soy *'
flour
Soy oil, stabilised
Vitamins & Minerals
6)
K M -2 '
Calcium caseinate
Dry skimmed milk
Sugar (Sucrose)
100
373
20 .0
352
21.1
73.4
20.0
^-0
2.6
100
.16.5
27.5
55.0
RECIPES FOR NOTRIT TONAL THERAPY CENTRES;
1.
Dry skimmed milk
Semolina (suji)
Butter oil
Sugar
100 ?ms
100 l!
80 II
n
175
Water added 1750 ml.
Total volume on final preparation- 2O5O ml.
Food values of. final preparation0- Calories- 2125
Proteins ?
48.0 pm.
Fats
•
84.0 rm.
CHO
: 236.0 gm.
2)
Dry skimmed milk
Corn starch
Butter oil
Sugar
Water added 2500 ml-
125
•100
80
15.0
rms
.
•
gms.
gms
gm s.
Total volume on final preparation-’ 2500 ml.
Food values of final preparation -.Calories- 2225
Proteins 47.5.gm.
Fats
20.0 gm.
CHO
s 320.0 gm.
3) Modified KM-2 <
Use Calcium Cpseinate (75 gm.) in place of Dry Skimmed
milk powder (100 gm.) in Recipe (2) above, retaining the other
constituents in the same quantity. Water to be added to be
decided by actual cooking-not done yet.
1
Food values of final preparation (volume to be worked out)
Calories- 1981
Pr ot e in •
47.5 gm Fnts
s
80.0 gm.
CHO
; 250.0 gmNote A As Ba lahar and CSM are readily available in sub
stantial quantities, the group recommended that recipes may be
evolved using these with a view to enhancing their caloric
contents. They can then be used in the feeding programmes.
contd «....
(b)
Using Schedule III above (Recine (I) two feeds and
Recipe'(II) two feeds a davTs
Dry Skimmed Milk.
Butter Oil
Sugar
Semolina (Suji)
Corn Starch
-
202.5 tons
145.8 tons
298.5 tons
101.25 tons
81.0 tons.
SUPPLYMEMTARY FEEDING PROGRAMME;
It is suggested that this programme be subdivided into
two portions. The first may be for children under 5 years and
the second for children between 5 and 8 years, pregnant women
and lactating mothers. The children under 5 years should be
.fed once a day under supervision in feeding centres. The
children between 5 and 8 years, pregnant women and lactating
mothers may be supplied with the supplementary food along with
the ration being distributed by the local authorities. It is
estimated that for every unit of 10.,000 total population, there
will be 1200 children under 5 years (excluding the 230. severely
malnourished children to be taken care of at the Nutrition Therapy
Centres as mentioned previously), 1500 children between 5 and 8
years and about 900 pregnant women and lactating mothers.
It is proposed that one supplementary feeding Centre for
these 1200 children under 5 years be opened along with the
Nutrition Therapy Centre. This will provide coverage of
supplementary feeding to all children under 5 years (0.6 million)
who are not covered by the Nutrition Therapy Centres proposed.
ESTIMATES OF QUANT IT IES OF FOOD REQUIRED FOR THE SUPPLEME NT ARY
FEEDING CENTRES f
~
Eacv child will be provide^ the equivalent of 75 gm. of
•dry Ba lahar/CSM/VSB and 25 gm. of Sugar per day. The requirement
per month of each centre catering to 1200 children will, therefore,
be about 2.7 tons of High Protein Food and 0.9 ton of Sugar. The
requirement for a month for the total of 0.6 million children will
be 1360 tons of II.P.F. and 450 tons of Sugar.
Tn’case Milk is to be distributed in place of H*P.F. the
requirement will be as follows. Each beneficiary will have to
receive- the equivalent of 50.gm. of Skimmed Milk powder and 50 gm.
of Sugar. This will mean an estimated requirement of 900 tons
of skimmed milk powder and 900 tons of Sugar for one month.
•
I
ESTIMATES OF ®ANTITIE.S OF SUPPLEMENTARY FOOD REQUIRED TO BE
DISTRIBUTED TO CHILDREN BETWEEN F TO_g BAB3, PRESORT WOMEN
AND LACImTING MOTHERS:
. t
The provis4on will be the same as in the case of children
under 5 years, that is, 75 gm. if IhP.F. or 50 gms. of skimmed
Milk Powder and 50 gms- of Sugar per beneficiary. If H.PIF. is
distributed the total requirement for one month for this group
will be 2700 tons. (It is recommended that H.P.F* may be used
for preparation of ’Roti' so that Sugar need not be supplied
to this group) . In case of Skimmed Milk Powder the requirement
will be 1800 tons of Skimmed Milk Powder and 1800 tons of Sugar.
It is recommenced that for tb/s group only H-P..F. be supplied
and not milk powder.
The requirements of food items for the’different groups
are summarised in Table I*
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ADMINISTRATIVB ARRANGEMENTS
The problen is so vast and the time factor so critical that
we recommend the involvement of all relief agencies that are
functioning effectively among the refugees today, be they govern
mental agencies, international agencies cr voluntary bodies. The
help and support of all is the need of the hour. The Indian Red
Cross is already involved in a significant way in the supplementary
feeding programme. The UNICEF and the World Food Programme and
other UN Organisations have a deep commitment. The State
administrative machinery together with the State Health Department
who have already worked very effectively in the general relief
operation wo,nld be in an excellent position to shoulder
responsibility for nutritional relief, provided they are given
the resources in men and materials. A number of voluntary agencies
may also be in a position to contribute successfully to the relief
operation.
Wo suggest the setting up of a high-level Co-ordinating and
Policy Committee for Nutritional Relief. The Committee would
have the authority to direct the relief operations and to mobilise
personnel and resources and provide relief expeditiously.in areas
most needed. The Committee would serve as a contact point with
national and international bodies connected with the relief work.
The composition of the Committee may be such as to provide for a
co-ordinated approach by the Central Government and the State
Government of West Bengal, Triaura, Meghalaya and Assam.
Representatives of international organisations that are- involved
in the relief efforts, such as the UNICEF, the World Food
Programme and the Red Cross, should be closely associated with
the Committee. The Committee vould centralize all resources,
national and international, it would have surveillance teams which
provide an assessment of the nutritional situation in the field
from time to time and serve a? a feedback mechanism to the
Committee.
It is strongly recommended that,the Committee should have
a full-time Executive Secretary and a full-time Joint Secretary
to function on behalf of the Committee and to take all steps for
the implementation of the relief operation through whatever
agencies they consider most arproprinte for the success of the
operation.
It is recommended th^t the Co-ordinating and Policy
Committee for Nutritional Relief should function in close
relationship with the Central Co-ordination Committee of the
Ministry of Rehabilitation.
The group emphasized that the nutritional therapy of very
sick children and the supplementary feeding of not-so-sick
children and of pregnant and lactatinr mothers should bo broadly
considered as an operation with similar aims and objectives and
as such the two should be as closely co-ordinated as possible.
It is also essential to see that the work of the nutritional
therapy centre's and of supplementary feeding centres is linked as
much as possible with the general medical relief operations thnt
are being performer’ by the health teams of the State Governments
amonr the refugees.
f
1)a)
HEALTH
ASPECTS
OF
DISASTERS' AND
REFUGEE
RELIEF -
9-io
e ■•!
PREVENTION OF DISASTERS
1. War
-
air raids (conventional) dangers of blast, schrapnel. fire, falling
buildings. Prevention of injury by air raid shelters,
living in underground train tunnels,
-
atomic bombs and missiles: similar dangers to above, plus retinal burns,
somatic and genetic damage (leukemia, skin cancer, congenital
deformities). No effective protection.
military campaigns: dangers of ruined crops, scorched earth policies,
refugees, injuries, assault, theft and murder in wake of
lawless area, veneral disease.
League of Nations; United Nations, Organisation of African Unity, etc., all
help, but no one seems to have the answer yet in man’s history.
2. Accidents
- rail crash: effective signals system; medical examination of drivers,
especially of eyes, colour vision.
- fire at sea: fireproof fittings, education in fire drill and prevention.
- collision
at sea:
radar, rules
- air crash:
- col 1iery
explosion:
- fire in
a city:
training of aircrew, ground staff, rules and thorough investiga
tion of accidents (see Haddon: Accidents), (Taylor, 1970)
testing for gas (birds, chemical tests), sparkproof tools.
No smoking, and bodily examination of miners for matches, etc.*
health education; nonflammable building materials and clothes,
fire brigade dril1,sprinkler system automatic fire dampening
* chemical dampening of blast wave in mine.
3. "Natural disasters"
- volcano eruption
)
- glaciers, landslides )
- earthquakes
)
activity can be predicted somewhat in all these
cases, especially tremors and quakes. Discourage
building in danger zones. Specially strong
construction.
- tidal waves, typhoon,
monsoon
- darn or dyke burst
no special preparation possible usually
- drought or famine
- forest or bush fire
no buildings near
adequate food storage
no smoking education, forest fire fighting teams
- pandemics (plague, typhus, cholera)
can be foreseen with religious
festivals, e.g. in Ganges, or at Mecca Haj.
Immunisation, sanitary' reform.
Most ‘natural disasters cannot be prevented , but most man made accidents are not
necessary. If you cannot prevent, you must prepare.
HEALTH ASPECTS OF DISASTERS AND REFUGEE RELIEF
contd.
PREPARATION FOR DISASTERS
1. Ambulance and mobile medical services
(a) First Aid training
Red Cross, Red Crescent, St John's
Ambulance Brigade
(b) Ambulances
(c) Ambulance ships ready to sail to disaster areas
(d) Ambulance trains, aircraft
(e) Ambulance helicopters
2. Air Sea rescue
(a) helicopters are the most useful of-all over sea or land
(b) lifeboats: these are superbly designed motor vessels capable of facing
the’roughest seas, and even righting themselves after being
•turned over in water
(c) plasitc and rubber dinghies, with or without canopies,
Should have medical kits, drinking water, rations for long
sea waits.
3. Land rescue
(a) Fire brigade: they can also cope with children in wells, collapsed
buildings, even snakes.
(b) Army: remember to call on Army or Police for major rescue work.
They have bulldozers, weight lifting equipment, stretchers,
drugs, etc.
(c) Mining rescue kits: these are compulsory in all underground mines and
include stretchers, morphine, bandages, etc.
(d) Blood banks: these are now essential at close proximity to international
airports, e.g. Kano. In 1956 a crash led to the discovery
that there was no blood available in that city.
(e) Railway rescue kits: needed at main stations, must include lights for
night rescue.
4. Mobile Hospitals
For refugees, war, and natural disasters it may be necessary to set up
hospital and emergency operating areas.
(a) Portable hospitals have been flown by helicopter in Vietnam
(b) Land rovers and trailer operating rooms are used in India
(c) Army tents are often available.
Rescue teams are usually part time or voluntary, such as lifeboat crews
who call their crews together with telephone or a loud signal from their
normal work to man the boats at a moments notice.
Fire brigade teams are usually full time.
International Teams
Not until the Pakistan refugee problem, when India was faced with 5 mill ion
refugees, with cholera, in June 1971, did the world wake up to the fact that
W.H.O. and UNICEF, etc., should have a permanent rescue team for medical rem*.'.
UNRRA was a similar body in the Second World War but was wound up and the r.O'-ey
given to UNICEF in 1949.
3
HEALTH ASPECTS OF DISASTERS AND REFUGEE RELIEF Contd.
IMMEDIATE MEDICAL AID
1. Estimate size of problem: In the Persian earthquake (see Said!, 1963) aerial
photography of damage was the only method,
if possible avoid crowds or disperse them
prevent looting and murder
watch for escaped criminals
involve police or army if necessary
3. Restore communications
2. Avoid panic:
• ■
radio, telephone, rail, roads
inform services local and international, radio, TV
Large dangerous establishments such as Atomic Energy Research
buildings; oil refineries, etc,, often develop a
4• Major Disaster Plan
Under a director, often medical, a whole plan of evacuation
or control is worked out. (Savage, 1970), (U.S.A., 1961):
e.g. use of telephone restricted to named individuals in a
named priority only. Health teams constantly on alert and
trained for action.
5. Rescue operations
Stop fire, especially if gas or electricity supplies cut
Need for 1ight
Bulldozers, lifting tackle, helicopters
6. Water and food
Can carry water in road tankers, rail, air, even (if by sea)
in huge floating plastic drums. Water is needed before Tood.
Food should be easy to distribute and carry, e.g. soup.
Involve Salvation Army if near, or Red Cross.
7. Clothing and shelter
8. Sanitation
Especially in extremes of climate, cold or desert.
May need evacuation.
Camp sanitation: involve army if large scale (Assar, 1971).
9. Morale
Good interpreters needed at rescue camps and reception centres,
and leadership capable of lifting morale.
10. Heal th
Treatment of injuries: especially shock, bleeding, gangrene.
Burns centre should be set up separately if needed.
Immunisation
The great fear is typhoid, typhus, cholera, dysentery, and
sometimes smallpox and meningitis.
Immunise at the border (if refugees) on entry.
Delay makes for difficulty in rounding up.
Supplies of cholera antibiotics, sulphonamides.
Long term prevention: BCG vaccine at entry to camp.
Antimalarials if non-immune (e.g. the Tutsi refugees of Rwanda
coming into lower lying Uganda where there was more malaria).
- 4 HEALTH ASPECTS OF DISASTERS AND REFUGEE RELIEF
contd;
AFTERCARE AND REHABILITATION
1. Medical examination
2. Medical care
3. Schooling
4. Rehabilitation
Long term care may begin by detection of disease or
disability by full medical examination not atfirst possible.
If possible employ uninjured medical and nursing staff
from amongst the refugees, prisoners, homeless, etc.
In Rwanda refugee camps in Uganda schooling was resumed
very quickly by camp commandants using Rwandan teachers.
French-speaking teachers moved to Ugandan schools to teach
French, while English speakers from Uganda entered the
settlements to help the new generation in settling into
the country of their adoption.
and resettlement of disabled
Open industry or normal farming, etc. if at all possible.
Sheltered employment if not.
RELIEF ORGANISATIONS
From 1940-1947 UNRRA (U.N. Relief and Rehabilitation Association) undertook the
resettlement of war refugees. It settled nearly 10 million, but left a similar number
still unsettled when it closed down in 1948.
2. International Relief Organisation set up in 1951-2; now the
3. Office of the High Commission for Refugees, protecting rights (employment,
education, etc.) and material aid programmes; also
coordinating relief agencies.
4. Inter-Church Aid
5. Oxford Committee for Famine Relief (Oxfam)
6. Save the Children Fund
(SCF)
7. Sal vati on Army
8. Food for the World
0- Red Cross, Red Crescent, (in Iran: Red Lion and Sun)
REFERENCES
1. Huckstep, R.L. (1967) Diagnosis and Treatment of Typhoid,'Livingstone
Inc. section on Mau Mau detainee camps where typhoid occurred.
2. Medical News, Oct.28, 1966. Aberfan Progress Incredible (Welsh mining village disas3. Saidi 2 Farrokh (1 963) The 1962 Iran Earthquake, New Eng.J.Med. 268,929
4. World Health (1963) April: Red Cross Centenary
5. ibid
(1963) Nov:
With the Refugees in Palestine
6. ibid
(1963) Dec:
Migration Today
7. ibid
(1963) Mar:
Hunger: the Disease of Millions
8. W.H.O. Monograph (1 965) Protection of the Public in the Event of Radiation Acci de_nt_s_
9. Savage, P.E.A. (1970) Disaster Planning: a major accident exercise, Brit.med.J. ? 168-171
-------------
10. Assar,M. (1971) Guide to Sanitation in Natural Disasters, Geneva: W.H.O.
11. Taylor, J.G. (1970) Air Disasters and Their Special Problems, Trans.Soc.Occup.Med.
TO,
R. Schram
April, 1973
Edited by
Dominique Side
ISSN No: 0254-9743
Vol:7 No:3 August 1984
NATURAL DISASTERS:
acts of God or acts of Man?
Earth scan briefing document No:39
Afar nomads in Borkhena Valley are
among
the
victims ' of
Ethiopia's
drought. Mark Edwards/Ear th scan
Six
times
more people died
from
disasters in the 1970s than in the
1960s, although the number of disasters
went up only 50$.
Why? This'document
argues that people are changing their
environment to make it more prone to
disasters and to make themselves more
vulnerable. While the trigger events droughts, . floods,
earthquakes
and
hurricanes
- may be
natural,
the
resulting disaster is largely man-made.
Droughts: In early 1984, 150 million
people in Africa were "on the brink of
starvation"
because
of
drought,
according to FAO. Lack of rain was
clearly to blame, but human activity
makes the situation worse.
The
Ethiopian highlands are
so
overfarmed, overgrazed and deforested
that erosion carries off one billion
tonnes of'topsoil a year. Eroded areas
are more prone to drought because the
soils retain less and less water - and
this make them more flood-prone, too.
Erosion similarly threatens the Andes,
where drought struck throughout the
high valleys last year.
CONTENTS
Natural Disasters: acts of God or acts of Man
1
Caution:- if you're poor the weather can kill you 3
Alone in the wastelands
4
Poor irrigation threatens world's cropland
4
South African mines: ignoring the health risks
6
Liver cancer: the quest for a aheap vaccine
6
The Water Decade: where is the software?
7
Measuring the benefits of water
7
Boats and nets versus pumps and latrines
8
Leishmaniasis: the forgotten disease
9
The togetherness that saves lives
Frogs or pesticides for Bangladesh?
Chinese fish breeding: "stereo" or otherwise
Natural resources and the economic crisis
Africa must conserve to develop
Water in Punjab
Learning to love trees in Thailand
Trees not just for burning
Sabah's development plans snubbed by the young
The London economic summit: divide and rule
Uruguayan sealing: the endangered hunt
9
10
10
11
12
12
13
13
14
13
16
Earthscan, 10 Percy Street, London W1P ODR, UK
International Institute for Environment and Development
Director: Jon Tinker
Telex: 261681 Cables: Earthscan London W1 Telephone: (+44) 01-580 7574 Er 01-636 6906
3
NATURAL DISASTERS
Flooded huts by Buriganga Rivers, Dhaka. Though rich and poor may live side by
side,.the poor are more vulnerable to disaster. Photo: Tom Learmonth/Earths can.
CAUTION: IF YOU’RE POOR THE
WEATHER CAN KILL YOU
Renee Sabatier (Earthscan)
LONDON:
An earthquake in Peru is
likely to kill 50 times as many people
as one in Japan. Japan can afford
strictly enforced building codes, while
the poor of Peru live crowded in topheavy mud and straw shacks on steep
hillsides.
Between I960 and 1980 the
average Japanese disaster killed 65
people
while the average
Peruvian
disaster killed over 2,900 people.
It is the poor people in
poor
countries
who
suffer
most
from
disasters such as earthquakes, floods
and droughts.
In Mexico City, for
instance, 1.5 million people live on
the drained bed of Lake Texcoco, which
floods completely when it rains.
In
Bangladesh nearly 15 million poor live
less than 10 feet above sea level.
When the Ganga floods or the sea rises
after a hurricane, they are defence
less.
Although disasters are triggered by
natural events, their prime cause is
man-made
environmental
destruction.
Disasters are as much social and poli
tical events which can be, and often
are, prevented.
Floods are increasingly severe in
India, though the rains themselves have
not altered much. The floods are caused
by deforestation and soil erosion. The
Himalayas act like a great forested
water machine, and in the past soaked
up the annual monsoons like a
giant
sponge, releasing the waters throughout
the year.
Now the lower slopes of the
Himalayas are nearly bare, flooding
uncontrollably after monsoon rains.
Effective disaster prevention de
pends on long-term planning toward a
more sustainable and less vulnerable
society.
Many relief agencies are now
concentrating
on development rather
than emergency aid.
Feature issued 15 June 1984. 786 words.
English, French, German and Spanish.
4
NATURAL DISASTERS
ALONE IN THE WASTELANDS
POOR IRRIGATION THREATENS
WORLD’S CROPLAND
Lloyd Timberlake (Earthscan)
John McCormick (Earthscan)
ADDIS ABEBA and NAIROBI: Some five
million
people are
threatened
by
drought and "desertification” in Ethio
pia alone. Yet a three-day meeting in
Nairobi (16-18 May) of the UN Environ
ment Programme (UNEP) Governing Council
promised little outside help to afflic
ted countries. They are on their own.
Some 40,000 sq km (15,400 sq mi) of
Ethiopia's
agricultural
land
are
reaching a stage of irreversible des
truction. Good land is so scarce that
some farmers tie themselves to stakes
and lower themselves by rope down vir
tual cliff faces to plough and plant on
land too steep to stand up on.
The
Nairobi
meeting
assessed
achievements since the 1977 UN Confe
rence on Desertification, where a "plan
of action" to halt desertification was
agreed. In 1984, UNEP Executive Direc
tor Mostafa Tolba admitted that deser
tification is proceeding faster than
ever, and many of the plan’s provisions
remain a "dead letter".
Blame for this inaction can be laid
at the door of the UN, accused of spen
ding too much on documentation and not
enough on action, and also with govern
ments both rich and poor, who fail to
give the issue priority.
However the basic fault may lie in
economic realities. Worldwide, agricul
ture has become non-competitive as an
economic system. The money spent on
reclaiming desert land, for instance,
would earn far higher returns if inves
ted in a bank. In the Sahel, few
regimes last as long as it takes a tree
to grow to firewood size, which helps
explain why so little is allocated to
reforestation in the region.
As a British delegate noted, "deser
tification" is not about deserts but
about badly managed rural development,
agriculture and forestry. The challenge
now is for the experts to suggest the
sort of effective, sustainable, soil
conserving techniques which will keep
Ethiopian farmers from having to dangle
over their fields at the end of a rope.
LONDON:
Poor irrigation is turning
farmland into wet, salty desert. Irri
gation should be part of the solution
to world hunger, but in many areas it
has become part of the problem.
Irrigation grows much of the world's
food.
Only 15$ of farmland is irri
gated, yet this already produces over
40$ of the world's crops. But if irri
gation projects forget drainage, if
local farmers are not consulted, and
management
and maintenance are not
worked out, then irrigation does more
harm than good.
Lack of drainage is the most serious
problem, as it can cause waterlogging
and salinisation (salt build-up in the
soil) and render the soil infertile.
Salinisation in Iraq's
Mesopotamian
plain, where irrigation first began
6000 years ago, has created thick salt
crusts which glisten like snow, and the
region now has to import food.
Salinisation affects 20-25$ of farm
land in Latin America, and is spreading
as fast as new land is brought under
irrigation.
The withdrawal of groundwater beyond
its capacity for replenishment is also
a common problem.
In California's San
Joaquin Valley (USA), it has caused
land to subside by as much as 8.5 m (28
ft) in places.
Poor irrigation can also aggravate
soil erosion by opening up ill-suited
land to agriculture. And if canals are
blocked, the stagnant pools which form
help spread water-related diseases such
as malaria and bilharzia.
To make irrigation work more capital
investment is needed,
farmers need
incentives to maintain the systems, and
the supply of water must be reliable
and
equitable.
Although irrigation
could thus be made more efficient, the
UN Environment Programme warns that
desertification of irrigated lands is
likely to be a threat for the foresee
able future.
Feature issued 1 June 1984. 1250 words.
English, French, Spanish and German.
Feature issued 11 May 1984. 755 words.
English, French, German and Spanish.
5
NATURAL DISASTERS
INFORMATION SOURCES ON DISASTER
PREVENTION AND PREPAREDNESS
UPCOMING EVENTS
The Second International Congress on Disaster
Preparedness and Relief, 1-4 October 1984, Palais
des expositions, Geneva, Switzerland. The Congress
will address fire prevention, disaster medicine,
rescue and evacuation, and relief housing. For
information
contact
the International
Civil
Defence Organisation (congress secretariat), 10-12
Chenin de Surville,
1213 Petit Laney, Geneva,
Switzerland. Tel: (22) 95 44 35. Or contact Mr Oi
at UNDRO (address below).
The Congress is taking place at the same time as
the "Emergency '84" exhibition of disaster equip
ment, which is most relevant to richer nations.
ORGANISATIONS AND CONTACTS
Canadian International Development Agency, 200 rue
du Portage, Hull, Quebec, Canada K1A 0G4. Contact:
Mr Jean Devlin, coordinator of international huma
nitarian assistance.
Disaster Information Service, Joint Assistance
Centre, H 65 South Extension 1, New Delhi 110049,
India. The service has an extensive library and is
preparing a catalogue of NGOs working in disaster
related fields.
Food Emergencies Research Unit, a joint project of
IDI (see below) and the London School of Hygiene,
Nutrition Department, Keppel Street, London WC1.
Tel: (01) 656 8656. Contact Wendy McLean.
International Disaster Institute (iDl), 85 Marylebone High Street, London W1M 5DE, UK. Tel:(0l) 955
0756. Contact Susan York, resources officer. The
IDI deals with disasters in the Third World only,
and has a reference library (phone for an appoint
ment as it is not open all week).
Intertect, PO Box 10502, Dallas, Texas 75207, USA.
Tel:
(214) 521 8921. Contact Frederick Cuny,
president.
Prevention better than Cure by Gunnar Hagman, Swe
dish Red Cross, Stockholm, 1984*
As part of its "Behind the Weather" campaign,
Oxfam has published three papers in 1984: "An un
natural disaster: drought in northeast Brazil";
Why the poor suffer most; drought and the Sahel
by Nigel Twose; and Lessons to be learned: drought
and famine in Ethiopia. Each £1.00 (inc 17 p&p)
from Oxfam Public Affairs Unit (address above).
Ecological Mismanagement in Natural Disasters
by
L.D. Pryor, International Union for Conservation
of Nature and Natural Resources, Commission of
Ecology Papers no:2, Gland, Switzerland, 1982.
Boletin de medio ambiente y urbanizacion, vol 1,
no:3-4, Oct 83. Special issue on natural disas
ters (in Spanish).
From CLACSO, Diagonal Roque
Saenz Pena 1110, P.6, of 3, 1035 Capital Federal,
Argentina. Annual subscription:- Argentina Sa 50,
elsewhere USS 3«5O.
Disaster Management,
tance Centre, H-65,
Delhi 110049, India.
quarterly, from Joint Assis
South Extension Part I, New
Emergency Preparedness News, biweekly, from Busi
ness Publisher Inc., 951 Pershing Drive, Silver
Spring MD 20910, USA. Aimed primarily at decision
makers. Annual subscription US$127.
IDI News from the International Disaster Institute
(address above).
It is published three times a
year, in English only, and is free of charge.
University of Reading Bulletin: the October-Novem
ber 1984 issue is on disaster mitigation, and will
mention relevant publications and contact organi
sations. Editor: John Best. Available from Univer
sity of Reading, Agricultural Extension Depart
ment, London Road, Reading, Berks RG1 5AQ, UK.
League of Red Cross Societies, PO Box 276, CH-1211
Geneva, Switzerland. Also contact national Red
Cross branches.
Oxfam,
56777.
nator.
274 Banbury Road, Oxford, UK. Tel: (0865)
Contact Marcus Thompson, disaster coordi
Swedish Red Cross, Box 27516, S-10254 Stockholm,
Sweden. Tel: (8) 670685. Contact Anders Wijkman.
United Nations Disaster Relief Office (UNDRO),
Palais des Nations, 1211 Geneva 10, Switzerland.
Tel:
(22) 34 60 11. Contact Gerald Dunn, head of
relief coordination and preparedness.
Ian Davis, Oxford Polytechnic, Gypsy Lane, Oxford
UK. Tel: (0865) 64777.
PUBLICATIONS
Disasters and Development by F.C.
University Press, Oxford UK, 1985.
Cuny,
Oxford
FILMS
Seeds of despair, 55 mins., col., 1984. Produced
by Charles Stewart. The film shows drought and
starvation in Ethiopia, and the environmental
degradation which makes the crisis worse every
year. Send loan/aales enquiries to Jean Denham,
Central TV, 35-38 Portland Square, London W1. Tel:
(01) 486 6688.
Managua earthquake? resettlement of a people, 21
mins., col. The film shows how Managua coped with
the 1973 earthquake and the lessons learned: new
construction techniques and deconcentration of
population and economic activity. From Vision
Habitat, Regional Office Europe, Room E-47, Palais
des Nations, CH-1211 Geneva 10, Switzerland. Free
loan for non-commercial viewing.
Why do the poor die? 29 mins 30 secs., col., 1981.
E. Vihtonen examines the causes of drought in
Ethiopia, how it could be prevented, who the vic
tims are, and the role of emergency aid. Produced
by Finnish TV, TV Centre, Helsinki 25, Finland.
6
HEALTH
ment "believes in "production at all
costs", and only when health problems
interfere with production or miners sue
for compensation will action be taken.
Feature issued 22 June 1984. 900 words.
English and German.
The
address of the South
African
Chamber of Mines is: PO Box 61809,
Marshalltown 2107, South Africa. Tel:
858 8211.
"I said, 'Don't tell the blacks that
Dorking in the mines will damage their
hearing'." Cartoon by David Austin.
SOUTH AFRICAN MINES:
IGNORING THE HEALTH RISKS
John McCormick (Earthscan)
LONDON: A recent unpublished report by
the South African Chamber of Mines
found that thousands of black - and
white - miners in South Africa risk
deafness due to excessive noise.
Pneumatic drill operators working at
the mine face endure noise over 110
decibels
(dbA) although the inter
national maximum standard is 85 dbA.
Most are likely to suffer permanent
hearing damage within 15 minutes of
starting their shifts. The miners now
have a recognised union, but only 12$
of black workers have joined and it
lacks the power to influence policy.
Ironically,
most of the
highly
skilled workers are whites, and they
are more exposed to noise as their jobs
are permanent. Migrant black workers
may partially recover between contract
periods. Even if the whites are aware
of the risks, they may keep quiet for
fear of losing their jobs.
Although a long-term project has
been launched to reduce noise levels,
there are still no schemes to test the
hearing of workers, either when they
start work or later. However surveys
among white miners have shown that up
to 70$ could be suffering hearing loss
entitling them to compensation.
The other health risks in the mines
include respiratory diseases from the
asbestos mines and accidents due to
intense heat and fatigue. The manage-
LIVER CANCER:
THE QUEST FOR A CHEAP VACCINE
Renee Sabatier (Earthscan)
LONDON: Liver cancer is found predomi
nantly
in
developing
countries,
especially in tropical Africa, South
East Asia and the Western Pacific. As
many as 40$ of all liver cancers occur
in China, and 15$ in Africa.
In almost 80$ of cases it is caused
by the 'hepatitis B’ virus which pro
duces symptoms of jaundice,
fever,
chills and nausea.
Infection can lead
to chronic liver damage followed by
liver cancer.
Once developed the can
cer is painful, incurable and fatal.
A vaccine against liver cancer has
been developed, but at around US$80 for
the required three doses it is prohibi
tively expensive for most of the coun
tries which need it. This is because it
is derived from the blood plasma of
hepatitis B carriers. The plasma is
extensively purified to isolate the
non-infectious
protein coat of the
virus, which then makes up the vaccine.
This process is more expensive than
conventional vaccine production.
The failure to grow the virus in an
artificial medium is the main barrier
to the production of a cheap vaccine.
Scientists
are researching ways of
overcoming this, and it is hoped a
vaccine may soon be manufactured by
genetically engineered yeast cells, or
through synthetic chemical processes.
Meanwhile, the disease claims 260,000
victims a year, and without successful
immunization this figure will continue
to rise.
Feature issued 18 May 1984.
English and German.
570 words.
7
HEALTH
THE WATER DECADE: WHERE IS THE
SOFTWARE?
Sumi Krishna Chauhan (Earthscan)
Dhaka:
The UN 1981-90 World Water
Decade has spent millions of dollars to
provide villages with pumps, pipes and
latrines, but little effort has been
put into the health education which
would help people use the new hardware.
The
simple practice of
washing
hands, for instance, prevents disease
carrying germs from passing from faeces
to food to mouth. But little research
or funding have gone to health educa
tion - or Decade "software" - and no
one knows how best to teach villagers
the simple techniques which can improve
health.
The most prevalent mythology is that
technology will produce results, but
field research in the remote Teknaf
area of Banglaesh indicates the reverse
is true: that software can be even more
important than hardware.
The
International
Centre
for
Diarrhoeal Disease Research, Bangladesh
(lCDDR,B) monitored two village clus
ters over four years (1975-79)• One was
given handpumps, pour-flush latrines
and hygiene education, the other was
given none of these. The control clus
ter
showed
no significant
health
improvements over the other cluster
and, despite some education, behaviour
was slow to change.
Project workers believe that changes
in behaviour take time, and when they
do occur health will improve consider
ably. What is clear is that technology
alone is not enough.
Feature issued 6 July 1984.
English only.
800 words.
MEASURING THE BENEFITS OF WATER
Sumi Krishna Chauhan (Earthscan)
LONDON:
The World Water Decade is
based on the assumption that safe drin
king water and better sanitation im
prove
health,
but several
recent
studies cast doubt on this belief. The
few studies which have linked improved
water and sanitation to a decrease in
diarrhoea have been conducted in very
special circumstances.
Dr Fitzroy Henry conducted a study
on the Caribbean island of St Lucia
which showed families using more water
had less disease, and that improved
water supply alone reduced the stunting
of children.
But the prject had com
plete
control of factors such
as
collection and storage of water in the
house, so conditions were untypical of
the Third World.
In Chile, Dr Oscar Brunser studied a
group of slum dwellers who were moved
to new housing with safe water and
modern sanitation.
The incidence of
diarrhoea remained the same, but the
less harmful varieties became
more
common than the serious ones.
In this
instance, the expensive new housing
makes the case untypical.
Although Dr Henry believes water
supplies can have an impact on health,
he finds that "the real question is how
to
transform that
potential
into
reality".
Feature issued 6 July 1984.
English only.
800 words.
FOR MORE INFORMATION ON WATER
HEALTH....
AND
Dr Oscar Brunser is professor of
paediatrics at the Institute of
Nutrition
and Food
Technology,
Casilla 15158, Santiago, Chile.
Dr
Fitzroy Henry is
currently
working at the International Centre
for Diarrhoeal Disease
Research
(ICDDR.B), GPO Box 128, Dhaka 2,
Bangladesh.
Dr Richard Feachem and Deborah Blum
have recently published a paper
reviewing 50 studies on the impact
of water on health; "Measuring the
Impact of Water Supply and Sanita
tion
Investments on
Diarrhoeal
Diseases",
in the International
Journal of Epidemiology, vol 12,
1985,
pp.557-565.
They can be contacted at the
London School of Hygiene and Tropi
cal Medicine, Keppel Street, London
WC1. Tel: 656 8656.
8
HEALTH
BOATS AND NETS VERSUS PUMPS
AND LATRINES
Sumi Krishna Chauhan (Earth scan)
Jalliapara,
Bangladesh:
This small
fishing village in southeastern Bangla
desh has been supplied with new wells
and latrines as part of the World Water
Decade effort.
The villagers
are
pleased to receive so much attention,
but when asked what they themselves
would have bought with the funds they
reply "fishing boats and nets".
Fishing is Jalliapara*s major occu
pation. Men chatting in a village tea
shop estimated that the total cost of
wells, handpumps and latrines in the
village was equivalent to that of four
fishing boats and nets, which could
support 40 households.
Improved water and sanitation are
not a priority for the villagers.
The
water table is high, and they tradi
tionally collect water from shallow
holes scooped in the ground. . Now al
most every house has a latrine, but
some villagers still prefer the river
bank.
Once the project stops, villa
gers wonder how they will maintain the
new pumps: where will they get spare
parts?
The main killer of newborn babies in
Bangladesh is tetanus, caused by rusty
razor blades used to cut the umbilical
cord.
This can be prevented by vacci
nating mothers, but "instead we give
them
tubewells",
said one
UNICEF
official.
An ideal situation would provide
water and immunisation, health care and
employment, but in practice villagers
and governments have to consider diffi
cult trade-offs.
For villages like
Jalliapara, the choice is crucial.
Feature issued 6 July 1984.
English only.
800 words.
SANITATION AND CITIES
- '
.*
■
:
-s<_'
Sanitation and Cities is the latest in a series
of photosheets produced by Earthscan to illust
rate development and environment issues.
The set consists of 9 sheets (297 x 210 mm),
seven with text, containing 46 black and white
photographs. The photos and text illustrate
the homelessness that faces over a billion
people throughout the world. The topics
covered include: shanty towns, housing the
poor, urban waste disposal, old and new
methods of sanitation and the problems of
waste water.
J**.
To draw attention to those without basic
shelter and services, the United Nations
has declared 1987 the International Year
of Shelter for the Homeless.
Price:
£1.50/$S.00
Individual prints available on request.
HEALTH
9
THE TOGETHERNESS THAT SAVES
LIVES
Renee Sabatier (Earthscan)
LEISHMANIASIS: THE FORGOTTEN
DISEASE
Andrew Crump (British freelance journalist)
LONDON:
It attacks 400,000 new people
every year, afflicts 12 million people
in the world at any time, and occurs in
South American forests, Soviet Asian
steppes, the Ganges basin, southern
Europe, and in North and East Africa.
Yet leishmaniasis is the most neglected
and least understood of all tropical
diseases.
It
is caused by a
microscopic
parasite
called
"Leishmania",
and
scientists are still uncertain how many
species of it exist. In Africa and
India the parasite is hosted by sand
flies, dogs and foxes; in Latin America
by sloths, armadillos, anteaters and
opossums, and elsewhere by rodents.
Leishmaniasis has several forms. The
fatal form attacks bone marrow and
internal organs. The skin form results
in a chronic ulcer which can disfigure
people even more than leprosy. The
disease is difficult to control because
the parasite can enter and multiply
within the white blood cells which the
body sends to destroy it. The only
known treatment relies on drugs based
on antimony, which is toxic and can
have serious side-effects.
Feature issued 22 June 1984. 675 words.
English, Spanish and French.
LONDON: If low birth-weight babies are
carried against their mother’s breast
kangaroo-style,
they are more likely
to survive than in an incubator.
Two Colombian doctors* are encoura
ging this method along with breast
feeding to ensure natural mother-child
bonding. They noticed a drop in gastro
intestinal infections and in the death
rate among these babies.
The babies
stay warm, gain the immunological pro
tection of their mother through her
milk, and are likely to develop motor
coordination earlier than unstimulated
infants.
Three years ago, half the babies
born under 2000g (4«4 lb) in one Bogota
hospital died, but today 95$ survive
with this method. Incubators cost be
tween US$2,000 and $12,000 and hospital
stays are expensive, so this low-cost,
low-tech approach is relevant in both
developing and developed countries.
*The two Colombian doctors are Dr Edgar
Rey and Dr Hector
Martinez,
both
working at the San Juan de Dios Hospi
tal, Avenida Primera 10-01, Bogota,
Colombia. Tel: 253 4044/4930.
Feature issued 25 May 1984. 565 words.
English, French, Spanish and German.
I would like to remind non-govern
mental organisations receiving the
Earthscan Bulletin, that you can
write and order one free copy of
the full text of any feature or
briefing document summarised in the
Bulletin, provided you do so within
six months of the Bulletin issue
date. The same applies for photo
sheets.
The Editor
FROGS AND FISH
10
Professor Zakir Hossain, a zoologist
at Dhaka University, predicts that the
trade will do serious ecological harm
over the coming 10 to 15 years. Bangla
desh may have to decide whether it can
make more by exporting frogs’ legs than
it will lose by importing pesticides.
Feature issued 8 June 1984.
English3 French and German.
"The conservation people put pressure
on the frogs' legs merchants 9 and this
is the compromise they came to."
870 words.
CHINESE FISH BREEDING —
“STEREO” AND OTHERWISE
Chen Wei (China Features)
FROGS OR PESTICIDES FOR
BANGLADESH?
Nurul Huda (Bangladesh Observer)
DHAKA:
Bangladesh has taken advantage
of a decline in frogs’ legs exports
from India and China to increase its
own trade. Some 1,500 tonnes - 42$ of
total exports - went to the United
States last year, and 59$ went to the
Netherlands. Other buyers include Bel
gium, West Germany, Britain, France,
Italy, Hong Kong and Malaysia. Export
earnings leapt from some $5 million in
1982 to $7*5 million last year.
The only species of frog to be
exported from Bangladesh is the Indian
bullfrog (Rana tigrina). These come out
of hibernation in April, before the
monsoon rains, and remain active until
the rains end in October.
Only a
decade ago, frogs were considered har
bingers of the monsoons, and killing
them was regarded as an offence against
nature. Cash has eroded this belief,
and frog hunting now provides a seaso
nal income for many Bangladeshis, from
peasants to middlemen to large expor
ting companies.
Biologists
are worried by
this
trend, because frogs eat more of the
sort of insects which are harmful to
crops than any other creature. A single
bullfrog may eat 150 insects per day.
There is a collecting ban from 15
April-15 May, during the peak breeding
season, but this is widely ignored.
BEIJING: China airlifted 550,000 carp
to Libya this year, and has sent dozens
of fish experts to Africa and Asia. It
is exporting a novel fish-rearing tech
nology called "stereo fish-breeding".
"Stereo" literally means "in three
dimensions", and the technique involves
all
ecological dimensions to raise
seven species of fish in the same body
of water.
Silver and big head carp
dine on plankton which floats on the
top; below them grass carp eat the
water weeds; black carp hunt for shell
fish
and molluscs on the
bottom.
Finally, common and crucian carp and
bream eat the leftovers.
Fish are raised in about 2$ of
China's rice fields, yielding 40,700
tonnes of fish a year. This not only
provides fish protein but can raise
grain production by 10$ because fish
devour harmful insects.
In Shunde county, south China, fish
breeding
is combined with silkworm
breeding. Mulberry trees preferred by
the worms are planted on the banks of
the fishponds and the leaves are used
to feed the fish.
A
fish
breeding
research
and
training centre has been set up near
Wuxi, eastern China, with assistance
from UNDP and FAO.
Would-be breeders
from Asian and Pacific countries are
being trained there in pond management,
artificial hatching, fish feed and use
of fertilisers.
Feature issued 4 May 1984.
English only.
550
words.
11
NATURAL RESOURCES AND THE
ECONOMIC CRISIS
John McCormick (Earthscan)
LONDON: The world is living beyond its
means. Unlike the Great Depression of
the 1950s, which stemmed from a boom
which went out of control, today's
recession is caused by the depletion of
natural resources, according to a new
report "State of the World 1984" pub
lished by the Worldwatch Institute, US.
Oil prices rose partly due to over
use of dwindling reserves. The rise has
slowed
growth in grain production,
weakened the car industry and depressed
the demand for steel, rubber and glass.
Many countries have not yet managed to
reduce their oil consumption.
Intensified
farming has
doubled
world food supplies over the past 20
years, but this has produced soil ero
sion "of epidemic proportions". Semiarid northern China is losing so much
soil that scientists in a Hawaii obser
vatory can tell when spring ploughing
starts by measuring the dust in the
atmosphere.
Grasslands are overgrazed, and since
1 976 there has been no growth in global
SUSTAINABLE DEVELOPMENT
beef output at all. Growing populations
help to deplete resources, and though
global population growth is down, it is
still high in those countries that can
least afford more people. Rural people
in Africa may soon face disastrous land
scarcity.
Renewable resource bases, such as
forests
and fisheries,
are
being
whittled away.
Worldwatch warns that
"in economic terms, the world is begin
ning to consume its capital along with
the interest". However if the problems
we face are of our own making, their
solution too should be within our con
trol.
"The issue is not technology or
resources", concludes the report, "but
awareness and political will". Only a
strengthening of political will can put
us back on a path of sustainable deve
lopment .
Feature issued 1 June 1984.
English and Spanish.
775 words.
"State of the World 1984" by Lester
Brown and the staff of the World
watch Institute, is published by
W.W. Norton & Co., New York and
London, price $15.95*
SUSTAINABLE DEVELOPMENT
AFRICA MUST CONSERVE TO
DEVELOP
WATER IN PUNJAB
Sumi Krishna Chauhan (Earth scan)
Kenneth Kaunda,
President of Zambia
LUSAKA:
Development and environment
are two sides of the same coin.
We in
Africa are coming to appreciate that to
develop our continent industrially or
agriculturally, we must conserve our
natural resource base.
Africa’s fundamental environmental
problems stem from poverty and its
offshoots: hunger, ignorance, disease,
crime, corruption and, above all, ex
ploitation of Man by Man. Indeed, one
of the prerequisites of environmental
protection is peace.
Among our most serious environmental
problems are the lack of inadequate
sanitation and water supply, and deser
tification.
Africa has had to exist
with the Sahara in the north and the
Kalahari in the South, but it cannot
continue to co-exist with an advancing
Sahara and a spreading Kalahari. The
severe drought persisting since 1980
has devastated our economies and is now
crippling the main rural development
programmes of southern Africa.
For us in Africa, concern for the
environment has two basic objectives.
Firstly, we should recognise the need
for promoting development in order to
eliminate poverty.
Our
development
activities must meet basic human needs.
Secondly, we should recognise the
need for good management and rational
use of our human and natural resources
to ensure sustainable development. We
must take a hard look at examples of
mismanagement of resources, such as
destruction
of vegetative cover by
bush-fire, deforestation unmatched by
reforestation, widespread poaching and
pollution of groundwater.
If unsound development is a major
cause of environmental problems, it
follows that development itself must be
analysed in order to prevent any nega
tive "side-effects”.
Policy makers and planners
must
adopt sounder methods in order not to
over-exploit,
misuse
or abuse the
natural resource base. The future of
Africa and its peoples depends on it.
LONDON: One of many key issues in the
recent violence in Punjab between Hin
dus and Sikh extremists is water. The
Akali party, chief voice for the Sikh
religion which dominates this northwest
Indian state, is demanding among other
things a larger share of the waters of
the Indus river basin.
Punjab state is blessed with abun
dant water, and has an extensive canal
system used for irrigation. But to the
south lie the mainly Hindu states of
Haryana and Rajasthan without any yearround rivers, which get their surface
water from the canals in Punjab.
The Green Revolution brought prospe
rity to Punjab in the 1960s and early
1 970s by introducing high-yield varie
ties of cereals which are notoriously
thirsty. It is tubewell irrigation that
made the Revolution possible, and some
20,000 were sunk each year in Punjab.
This growth depended in turn on elec
tricity to power tubewell pumps, and in
this region most is hydroelectricity.
So water is crucial to the prosperity
of Punjab and all of northern India.
Now water is in shorter supply. In
Punjab’s Malerkotla district, overuse
of groundwater has lowered the water
table from three to nine metres (10 to
30 ft), so pumping consumes more elec
tricity. Many dams built for irrigation
and electricity generation are
now
badly silted due to deforesation up
stream in the Himalayas. And during
periods of peak electricity demand,
irrigation must be done at night when
farmers cannot see well and therefore
tend to waste water.
The issue of Punjab's legitimate
share of the waters is, of course, now
mixed with other religious and politi
cal demands. The Indian Marxist Commu
nist
Party has urged Mrs Gandhi’s
government to set up a water tribunal
to settle the matter. Natural resource
issues are playing a growing role in
civil strife around the world, and
governments cannot afford to neglect
questions of land, deforestation, soil
erosion and irrigation.
€
Feature issued 29 June 1984. 835 words.
English and French.
Feature issued 29 June
words. English only.
1984.
1^180
13
TREES
LEARNING TO LOVE TREES IN
THAILAND
Yojana Sharma
(Earthscan’s Brussels correspondent)
KORAT,
THAILAND:
Poor farmers and
forestry officials have clashed for
years in northeast Thailand, the far
mers wanting food for
today,
the
foresters protecting forests for the
future. Farmers have threatened fores
try workers, pulled up seedlings and
"An investment for the future? As far
even tried to start forest fires. There
as I'm concerned, the future means
are signs that peace is at hand.
tomorrow's lunch."
Intense farming in the fertile south
is squeezing the poor and landless
northwards. Three-quarters of northeast
saw the trees as standing in the way of
Thailand, once half covered with hard
their own survival.
wood and evergreen trees,
is
now
barren. The government is so alarmed at
Feature issued 18 May 1984. 735 words.
the speed of deforestation that it has
threatened severe punishment, including
English only.
summary execution,
for the illegal
cutting of trees. Such threats are
aimed mainly at poachers of valuable
hardwoods.
But
for political reasons
the
government is also committed to aiding
farmers in the northeast, which borders
TREES NOT JUST FOR BURNING
on communist Laos and Kampuchea. It is
aiding agricultural development there,
Horace Awori (Nairobi Times)
while at the same time
encouraging
farmers to plant trees.
NAIROBI:
This year, Kenya's National
Key to this policy has been a type
Tree Planting Week focussed not on the
of land reform whereby farmers are
given ’user rights' to land which tech
need to plant trees so much as the
nically belongs to the forestry depart
usefulness
of the trees that
are
ment. Each family can cultivate and
planted.
With the fastest growing
profit from about 2.5 ha (six acres)
population in Africa, and some 90$ of
without owning it outright. Families
the rural population entirely dependent
are
grouped
into
'agro-forestry
on wood for fuel, Kenya recognises it
villages', and water, roads and schools
may soon face a firewood emergency.
are supplied to each village. Security
Yet Kenyans do not only want trees to
of tenure means farmers can get bank
burn - they also want trees which can
loans for . farm implements, seed and
feed cows and improve the soil.
fertiliser.
Since Kenya's Tree Planting Week
The land is given on the condition
began 19 years ago, over 160,000 ha
that they plant a certain number of
(595,400
acres)
of
quick-growing
trees.
In early 1985, the forestry
trees such as cypress, pines and euca
department
reported
"nothing
but
lyptus have been planted in reserve
trouble" in its attempts to enforce
areas. But tree planting has not taken
this rule. By mid-1985, however, far
root in most rural areas. Landless
mers began planting fruit trees around
peasants (25$ of the population) are
their homes and were asking for eucaly
often hostile since forestry projects
ptus seedlings.
It seems they were
compete for scarce agricultural land,
prepared to plant trees once their own
and many peasants cannot afford to buy
the wood.
basic needs were met.
They no longer
14
TREES
Recent indications,
however, are
more hopeful. One survey showed that
many landowners are now planting more
trees. And the National Council of
Women is promoting a "green belt move
ment" in the country.
Kenya's tree planting programme has
lately emphasised 'agroforestry', the
growing of food crops and trees simul
taneously, often connected with the
raising of livestock.
Agroforestry is
highly suitable for Kenya’s arid and
semi-arid regions, since tree species
such as black wattle, which fix nitro
gen in the soil, can improve soil fer
tility. Millet yields are known to have
increased in dry areas of Kenya where
fields have been interplanted
with
certain acacia species.
Officials
see agroforestry as a
revival of traditional African prac
tices from the times before monoculture
was introduced by Europeans.
SABAH’S DEVELOPMENT PLANS
SNUBBED BY THE YOUNG
settled cultivation have been hit by
severe manpower shortages, and have
been snubbed by the young who prefer to
wait for more lucrative office jobs.
The Sabah Forestry Development Autho
rity (SAFODA) looked for settlers to
plant a forest of hardy Acacia mangium,
which grows up to 10m (53 ft) in two
years, around the village of Karamatoi,
south of Sabah’s capital, Kota Kina
balu.
Inducements such as two-room
houses connected to water and electri
city were offered, and settlers were
promised a share in plantation owner
ship and profits. Yet there have been
so few applicants that only 50$ of
SAFODA's land is settled, and the state
is farming the rest commercially using
hired labour - mostly immigrants.
The same holds true for other pro
jects. A new pepper farm near the town
of Keningau, which expects to make
large profits, had to recruit most of
its workers from elsewhere. Efforts to
popularise high yielding strains of
rice have also failed. 80$ of the area
under rice in Sabah still uses tradi
tional varieties because smallholders
will not accept the extra work and
extra risks,of higher yielding crops.
So Sabah s tribespeople continue to
tend their smallholdings by traditional
methods, growing food for the clans.
Whether they can be persuaded to farm
for
the
market - and so
support
development plans - remains uncertain.
Dilip Mukerjee
Business Times, Malaysia
KUALA LUMPUR: Plans to develop new,
high value crops, improve yields from
existing ones, and encourage the tribal
peoples of the Malaysian state of Sabah
(on the island of Borneo) to change
from shifting slash-and-burn farming to
FARM AND COMMUNITY FORESTRY
by
Gerald Foley and Geoffrey Barnhrd
This is the third title in Earth
scan’s series of technical reports
on energy issues.
The book eva
luates the experience to date with
community forestry, and describes
the lessons learned. It includes
sections on farm forestry, tree
growing for family uses, community
forestry,
and
land
allocation
schemes, and covers key aspects of
programme design and implementa
tion.
256 pages, with photographs and
references. English only. Price:
£10.00/US$20.00.
No free copies
available to NGOs. Orders to James
Deane, Earthscan London.
Feature issued 8 June 1984,
English only.
Feature issued 25 May 1984.
English and German,
746 words,
850 words.
15
”Some day 3
yours.”
NORTH/SOUTH
my childrenthis will
be
THE LONDON ECONOMIC SUMMIT:
DIVIDE AND RULE
The Organisation for Economic Coope
ration and Development (OECD) estimates
the interest bill of all developing
countries in 1984 at $55 billion. Ame
rican interest rates recently rose two
percentage
points in three months,
nearly wiping out the balance of pay
ments advantage gained by the South on
the back of economic recovery in the
North. Yet .summit leaders agreed no
thing that might reduce interest rates.
If rates continue to rise, multi-year
rescheduling will be powerless to avert
disaster.
Beside this, the contribution of the
London summit seems largely irrelevant,
and the Third World is likely to see it
as an exercise in divide and rule.
Feature issued 15 June 1934. 969 words.
English> French3 Spanish and German.
Rupert Pennant-Rea
(The Economist, UK)
LONDON:
The London economic summit
rejected any far-reaching action to
resolve the developing countries’ debt
problems.
Instead it called for banks
to reschedule the debts for several
years at a time for those countries
which were ’’making successful efforts
to improve their financial position".
The summit endorsed the "case by
case" approach which had emerged from a
meeting of the International Monetary
Conference
in Philadelphia a
week
beforehand. The approach stems from the
unwillingness of western governments
and the International Monetary Fund
(IMF)
to support any comprehensive
remedy
for
Third
World
debt.
The bankers have agreed to "multi
year rescheduling" for Mexico, a sen
sible but far from revolutionary con
cession.
Instead of negotiating a new
schedule for each loan as it comes due,
the banks will deal with several years’
worth of loans at a time. Rescheduling
a year's loans can take several months
of work, and thus create the impression
of near-permanent crisis.
A smoother programme of debt repay
ments
will make longterm
planning
easier for debtor governments, but the
size of the debt and - most crucially rates of interest remain the same.
A FEW SOURCES ON THIRD
WORLD DEBT
Rupert Pennant-Rea ia a journalist on The Econo
mist, 25 St James Street, London SW1 1HG. Tel:
(01) 859 7000. Telex: 919555.
World Development Movement (WDM), Bedford Cham
bers, Covent Garden, London WC2E 8HA. Tel: 856
5672. Contact David Ward. WDM campaigns on many
development issues, in particular British and EEC
aid and trade policies.
Global Negotiations Information Project, Church
Center, 11th Floor 777 UN Plaza, New York NY
10017, USA. Tel: (212) 682 5655. The Project pub
lishes action notes every 2 months with an update
on North/ South negotations.
The Centre d’Etudes Anti-Imperia-liete (CEDETIM)
has just published a series of three bulletins (in
French) on the state of play in North/South talks,
with a section on debt. CEDETIM is at 14 rue de
Nanteuil, 75015 Paris, France. Tel: (1) 551 4558.
Annual subscription to 4 issues: 80FF (France),
100FF elsewhere.
Comercio Exterior de Mexico is a monthly news
letter on Central and South American economies
published by Banco Naoional de Comercio Exterior,
Publications Department, Cerrada de Malintzin 28,
Col del Carmen, 04100 Mexico DF, Mexico. Tel: 549
5447. In Spanish, with English and French summary
editions. Free of charge.
16
ENDANGERED SPECIES
URUGUAYAN SEALING: THE
ENDANGERED HUNT
G. Nelis Ayala
(Uruguayan communications and environment
specialist)
MONTEVIDEO, URUGUAY:
Each year the
sale of sealskins brings Uruguay US$
400,000 in badly needed foreign ex
change, and seal harvesting supports
over 100 Uruguayan families.
But the
European
Parliament recently banned
imported sealskins from the endangered
Phocidae family, and since then sales
to Europe have plumetted.
The irony is that the Uruguayan fur
seal is not a member of the Phocidae,
but belongs to the Otariidae family
which is not endangered here.
In fact
the Uruguayan seal population has in
creased from some 20,000 in 1950 to an
estimated 300,000 today.
Uruguayan
biologist
Dr
Isaias
Kimenez claims this increase is due to
the enlightened culling method used.
The
cull takes mainly adult males
which, if left alive, would fight each
other to breed with females during the
mating season. As the females normally
give birth a few days before coming on
heat again, the seals' rough and tumble
breeding occurs among the
new-born
pups, many of which are crushed by the
males during courtship battles.
Adult males outnumber females by a
ratio of six to one and can be culled
without endangering the
population.
Experts agree that the annual cull has
reduced the number of pup deaths from
crushing, and so the total number of
seals is growing.
European importers are often unaware
that the flourishing 'lobo' is not
Uruguayan fur seals on the
Lobos. Credit: Nelis Ayala.
Isla
de
endangered, and are reluctant to spend
money on publicising the distinction
between it and other seals.
For Uru
guayans, it is the hunt itself rather
than the seals which is endangered.
Feature issued 11 May 1984.
English and Spanish.
550 words.
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K' hormer Hres,denL
ZogClAL SECTION: Disaster at Buffalo Creek
family and Character Change at Buffalo Creek
p jaMESL. TiTCHENER, M-D., AND FREDERIC T. KAPP.M.D.
^.(hiatric evaluation teams used observation* o'
lamilv interaction and psyclu ’analytically oric med
individualinterviews to study the psychologic«./
oficrefficts of the 1972 Buffalo Creek disaster, a tidal
taw ofsludge and black water released h\ the
ndltipseof a slag waste dam. Traumatic m urotie
tractions were found in 80Cc oj the survi\ ors.
Underlying the clinical picture were unresolved grief,
ivnivor shame. andfeelings of impotent rage and
hopelessness. These clinical findings had per\ •' a cdfor
ihf two years since the flood, and a definite symptom.
mmples labeled the “Buffalo Creek syndrome" was
pervasive. The methods used by the survivors to cope
dih the overwhelming impact of the disaster—first•tilerdefenses, undoing, psychological conservatism,
and dehumanization—actually preserved their
lymptoms and caused disabling character changes.
I
• On February 26, 1972, an enormous slag dam gave
M’ and unleashed thousands of tons of water and
• Hack mud on the Buffalo Creek valley in southern
•
Virginia. This Appalachian tidal wave destroyed
, Dcryihing in j(S path, killing 125 people and leaving
;
homeless and carrying away human bodies,
Hxises. trailers, cars, and other debris. It expended its
10rce in no more than 15 minutes at any one point in
i
IK-mile-long valley.
Ju^t below the dam and the tipple of the Buffalo MinCompany stood the town of Saunders; there was
, • lucc of this town minutes after the black water
through the dam. The sides of the valley are
an^
wa^ °f waler and mud caside to side, miraculously sparing some
. J
P^th annual meeting of the American Psychiatric
homes but destroying many others as it slammed down
the valley.
The wall of water sped through 14 mining k.mletx
with names like Crites, Bccco, Lur.dale, and Pardee.
hitting their schools, churches, taverns, stores, and
homes, leaving no trace of some and damaging nearly
ali. The sides of the valley become less steep and it
spreads out. so the black sludge and water became
more of a “flash flood” at Amherstdale and jus! an
overflow at Man, where it reached the Guyandotte Riv
er.
None of the settlements in Buffalo Creek which had
a total population of 4.000-5.000 inhabitants were in
corporated. There was no governmental organization
beyond the commercial structures provided by post of
fices, schools, and churches. There are five deep
mines in operation and evidence of stripmining is ev
erywhere. In spite of the stripping, the ugly r’pples the
dozen or so huge black heaps of waste, the railroad
and highway construction, it is still a beautiful valley.
and young adults there will tell you it was once much
more beautiful, with pleasant homes and gardens
where there are now primarily mobile homes. w .s
and is'a middle-class.area. Nearly all families arc sup
ported by employment in the coal mines o* in the sup
porting industries and services. There is an accepted
’(but not documented) belief that this valley had not
had the degree of emigration of young people that
typified others like It since the Depression.
There.had been rumors for years that the dam would
give way, but hundreds of people reported they.did ntn
believe it had really happened until a few moments af
ter the fearsome’sight and sound of the advancing wa
ter. Aik the survivors know' that the time 6t the darn
break (8:00 a.m. on a Saturdaj morning) wis fnitu*
Rfite. Few people*were down in the road, and the chil-.
dren were not in or waiting for th< school busss- Nev
ertheless, 125 were killed, and most lost their homes
and possessions.
Subsequently, a group of 654 surv ivors of thi ? disas
ter from 160 families began a legal action against the
Am J Psychiatry 13.1:3. March /v/O
>5
I
I
A >»'» v H \K-\x
. I
n. L i > V. u
■
I
I
JI
company that owned the dam. This group contacted
feelings and ideas aroused by the traumatic exL<r
of the’disaster and the very uneven attempts of
’
the iaw firm of Arnold & Porter in Washington.’D.C.,
vivors to reorganize themselves and redevelop^*
and ? legal team headed by Mr Gerald Stern traveled
tered coping and adapt've mechanisms. The4^* I
to the area to interview survivors. His observations.of
sociated with the catastrophe and its aftermath,
the psychological effects of me disaster and a summary
as the psychological and social wa;s these*
of the litigation are presented in “From Chaos to Re
chose to deal with them, must be seen against the(
sponsibility” in this section. 1 he law firm first con
ground of the universal crises of human develop^ c
tacted Robert J. Lifton. M.D.. who assessed “The HuThe attendant threats of Reparation, abandons c
. man Meaning of Total Disaster” (1). and Kai Erikson,
castration, and death—residuals of the developer^ j?
* Ph.D.. whose observations of the situation in the comcrises of separation and individuation—provide j
’ mun.ty are presented in “Loss of Communality al Buf
context for the- meaning of the catastrophe to the
I
falo Creek.” I'he suit was settled in July 1974 for $13.5
vors (2, 3). ,’z
’
|
million of which $6 million was for psychological
We found a definite clinical syndrome in the
»
damages.
vors of the Buffalo Creek disaster that arose from |
The legal team then retained one of us (J.L.T.) to or
ganize a group of experts tojnterview the survivors
the immediate impact of the catastrophe on eachua »
and assess for the court the psychological impairment ■ . . vidual and the subsequent disruption of the coi.^ J
!
they had suffered as a result of the flood. This paper ' nity and that affected everyone living there.
presents our findings on the severity and duration of
predisposed by previous experiences to be traun*
tized by pathogenic forces as destructive andawexx*
these psychological effects, a symptom complex we
as the Buffalo Creek catastrophe. Variations in thej
have labeled the. “Buffalo Creek syndrome.” The size
and composition of the evaluation teams varied with • ical picture resulted from individual difference* 1 j
modes of processing and reorganizing the traumatica ’
the nature of the families assigned to them. A full-sized
team consisted of a general psychiatrist, a child psychi
perience (4).
A clear pattern emerged from our evaluations mi |
atrist. and two psychologists or case workers. These
analyses. A traumatic neurotic syndrome Wu* dw I
teams did their work in the valley itself, visiting the re
nosed in more than 80% of the survivor-plaintiff*.* g
spondents’ mobile homes and those houses that were
changes in character structure were equally
still standing.
spread. These changes, although they were attempts
We conducted a pilot study consisting of interviews
readjustment, occasionally resulted in maladjustm i
of 50 survivors in June of 1973. The court then directed
in the social sense and always went in the directioa1 f
that all of the survivor-plaintiffs be interviewed, as all
psychologically disabling limitations.
|
were bringing suit separately. These evaluations were
Character changes represent the stabilizing ncw»
carried out on several long weekends in the spring of
sis, the psychologically hardening and fixating f
1974.
sequences of the catastrophe. We found conscious f
We began each evaluation with a family interview in
latent meanings and understandings and
which we asked the survivors to talk about their expe
standings of the disaster and its aftermath, all of
riences on the “day of the black waler” and during the
were associated with the feelings and conflicts an**
weeks and months that followed. As they talked, we
by the trauma. The result of this was changes in W j
were able to see beyond the immediate clinical phe
nomena to these people’s underlying feelings and their
relations and attitudes toward the self. We
various processes of reorganization—attempts Ji r* |
ways of coping with them. The family sessions were
ting personality functions back together—-that
followed by psychoanalytically oriented individual in
reeled toward reintegration and resumption of* |
terviews with each family member, conducted in back
yards. living rooms, or on porches.
traumatized life.
.
j
We shall indicate below how this personalityrc^ g
nizalion, which was so aimed al prevention o<^
ring experience of lhe traumatic state, aCtl1^- j
EVALUATION FINDINGS*
fered with flexible and effective recovery and 1 * *
served symptom patterns and forced change* j
Disabling psychiatric symptoms such as anxiety, de
pression. changes in character and lifestyle, and malad
way of life.
y
justments and developmental problems in children
were evident more than 2 years after the disaster in
u
SYMPTOMS AND CHARACTER CHANGES
ovtr W( of the individuals we interviewed. We asked
ourselves whether we were examining people who
were presenting major symptomatology and character
During the first days and on into the
problems that resulted from basically weak ego struc
months after the disaster, lhe survivors
‘
tures and who were using the disaster in order to win a
organization and sluggishness in thinking
y>
large settlement from the mining company. Our an
making. They complained of having
'*
swer was and is “no.” In our evaluations, wc wit
trolling their emotions. These problem* r
■
nessed difficult and prolonged struggles with powerful
emotional outbursts to lhe simple inability to
,
Ij
1
Ij
B
•
Am J fxychtairy MJ :3. March /976
described transient hallucinations and de.Almost «th rcp(M-lcd anxiety, grief, and dcL'^uith severe sleep disturbances and nightmares.
anxiety was. manifested in obsessions and
^’^jibout water, wind, rain, and any other rcminddisaster could recur. Occasionally these obdisturbances coalesced and became a group
^'mcnon. Tor instance, the wife of a community
never slept when he was asleep so that one of
p*uOlIld always be on the alert. On rainy nights,
*^n received phone calls regarding rumors that an> f Jam was about to give way. He would then take
nfle and spend the night sitting .on the supposedly
likened dam. guarded by others to protect him from
over the l°ss of relatives, friends, possessions,
. mementos such as family Bibles, as well as the
of the feeling of commonality discussed by Dr.
was widespread. For many, unreso’vcd grief
|irT)Cj into depressive symptoms, ideation, and behav< and some developed a depressive lifestyle (5). In
.me individuals, depression was channeled into a
mfr range of somatic complaints, with probable inftcases in the incidence of duodenal ulcer and hyper
tension.
Many of these people have become listless, apathet
ic nd less social since the disaster. They cling to their
families. lack ambition, and are disinterested in former
hobbies and sports. These changes have led to an over
all limitation of essential expression, a lack of zest for
wrkand recreation, and despair about ever again re
aming the lifestyle they once had.
THOUGHTS, FANTASIES, AND FEELINGS AROUSED
IYTHE DISASTER
The survivors referred to the disaster as “the end of
W’ or “the end of everything.” and noted that “No
one who was not there could ever really know what
Opened.” They were haunted by visual memories
dd emotions associated with the drownings of rela
tes and friends and of blackened bodies and parts of
Wiesthal were uncovered for weeks after the flood.
All of the survivors had to confront the loss of a
•r.se of personal invulnerability. The former feeling of
c°nifon and assurance about the continuity of life had
^N-nded partly on magical beliefs that horrible things
disaster do not happen to one; that they could
.occur in nice sane communities in this country.
'^Pihe impossible happened. The shock was over•1,lngand a new outlook took form that reflected a
‘‘“•bfrom the former sense of invulnerability to pesdemptiness, and hopelessness, We heard such
'^••‘•knt\ a-j “Nothing counts anymore”; “What’s
jV" now?’’; and “Since we lost everything, what’s
. * rained by trying’?” The'disaster took on the
chaos, helplessness, and death, giving rise
U1 Personal insignificance.
4 UCI’ other reactions contributed to depressive
symptoms and lifestyles. The first was a fedins r.r
potent rage over the destruction to life, property. and\
way of life. Thi> rage is an explosion of feeling Aiza—x*
the attack on the self. The victim has little nutlet for
his linger or hope of satisfaction. This feeling had spe
cial intensity because the destruction in Buffalo Creek
was man-made; it was caused by the inexplicable in
humanity of a powerful corporation that gave (emb’e
evidence of not caring about ns employees or their
community. The survivors' guilt was expressed in a
wide variety of derivative feelings about the self, in
symptoms, in character change, and in bcb.is’or
through self-denial and lack of hope. These conflicts
were not resolved, and their persistence took form in
identification with the dead in drcams, actions, and at
titude toward life (6).
No one behaves exactly as he thinks he should in a
hazardous situation, particularly in a situation he is
powerless to influence. Memory becomes clouded and
feelings of helplessness influence the way one looks
back on the traumatic event. Many people in Buffalo
Creek manifested “survivor shame.” One of the ac
tual heroes of Buffalo Creek, who had been extmordi-'
narily effective in mobilizing and leading rescue ef
forts. was able to fend off depression and anxiety in the
first four weeks after the flood while he worked relent
lessly to help others. When he attempted to return to
his former work, he was overwhelmed by anxiety and
depression connected with feelings of inadequacy. He
developed a phobia connected with his job. begun
drinking heavily, and became clinically depressed.
We noted in many people a sense of isol.ition and
feelings of alienation combined with an increased need
for vigilance and a tightening of the ring around the
family. Former feelings of self-assurance. sociability.
trust in neighbors, and enjoyment of community activi
ties disappeared. The isolation we observed'clinically
can be explained by the depressive : eactions. the
chronic anger, the loss of a way of life , and tne dissolution of self-confidence and basic tiust.
It has been hypothesized that the emotional distur
bances aroused in the victims of disaster quickly d.sappear after the stress has subsided. Our work at Buf
falo Creek suggests that this is rarely the case; (he man
ifestations of a traumatic neurosis do no* suhs.de with
the receding flood waters. 1 he effects may teem to dis
appear quickly if one is not alert to the subtle co.erm<up behavior of the victims of a psychic trauma.
Liflon'and Olson (1) explain the persistence of trau
matic effects on the basis efan analysis ot the t-atec <H
the disaster itself and the special psychological effects
of such an experience. Our study compleiycnts tf.c.i
work by showing how the effects ot a traumatic esc/u
are preserved by the modes o! adapt
whelming fears a’v.d hopelessness. 'I he
to protect self, family, unJ community tfo.Ti U
•rence of helplessness and loss are responsible tuf l'-c
individual and societal neurosis and rcsiricijse .... .r.*.
ter change. Our combined approach has bcri. io . ow
what occurred, the nature of its impact
the p
Aim J^ycb'airy 13^:3. Stafch
rAV.IL*
\>L> QHAHA* ffert UlASUL
and why its effects became Chronic.
One can analyze the sequential formation of the
“Buffalo Creek syndrome" as follows. The disaster aqtjvatvd intense affects, inclining fear. rage, and help
lessness. These waves of external and internal overstimulation overran the stimulus barrier and .the ego’s
capacity to integrate the traumatic experience and con
trol and discharge the affects. There was temporary
ego collapse and the ego was damaged. We estimate
that reorganization of the ego in whole or in part re
quired 6 to 24 months. The course of the reorganiza
tion and the way individuals processed these affects,
memories, and the associated conflicts made the ulti
mate difference in outcome. The survivors’ course of
ego reorganization and their manner of processing the
disaster experience were reflected in their symptoms
and character change (2,4, 7, 8). The variables in the
reconstitution of the personalities of the survivors we
studied can be divided into four categories.
PERSONALITY RECONSTRUCTION
First-Order Defenses
There was a continuous and steady deployment of a
coordinated system of character-shaping first-order de
fenses (9), i.e.. projection, externalization, and denial
Projection defended against-feelings of guilt and shame
aroused by the disaster. The constructors of the dam,
state and federal agency representatives, and intru
sions from the society outside of the valley became ob
jects of increasing anger and fear. Externalization
blocked awareness of this anger and fear as well as
feelings of helplessness. Individuals became sensitive
to and acutely observant of the anxiety and unrest in
their families, coworkers, and the social group. Denial
defended against recognition that the self had been
changed in any way; it disavowed the feeling of help
lessness and the awareness of psychological scar
ring (10). Denial enabled people to believe that while
much had happened to them and to those around them,
they had not been affected in an essential way, and
that they were the same people they had been before
the flood. This defensive complex projected against
emotions that would have otherwise reactivated mem
ories and feelings of fright and helplessness. It was ori
ented to the present and functioned continuously, pre
venting the gradual recollection and discharge of the
feeling of helplessness and blocking recognition of the
irrationality of shame and guilt. Although one can nev
er be the same after an experience with disaster, this
defensive system provides a desperate sort of status
quo that substitutes for personal regrowth. .
Eforis to "Undo" the Disaster Experience
Undoing consisted of efforts to change the past by
reliving the disaster in dreams and other ways, giving
• it a dillcrent outcome. Survivors’ memories of the
eari> postdisaster period contained fantasies of magi
cal reliving of childhood stresses. Attempts at undoing
298
Am J Psychiatry /.GJ, March 1976
also appeared in strange, symbolic reenact mem «
trauma, sometimes leading to violence to u*
others. Freudian repetition compulsion
placed by the mechanism of undoing, wh;chi/**
fense against facing the anxiety assocatcd
trauma.
•
•
The dreams of the survivors during the pcrxxl
tial shock and (in many cases) for months thcrtJ7
were fantasied attempts to relive the disastci. but^A
a less painful outcome. At first, such dreams\crt^
successful and people awoke from them in tenor 7
time passed, the dreams were modified. Although
affects remained frightening, the subject matter
from the flood to previous, often long-past, inu^qt
chaos and threats of annihilation. The dreams n > iom
er involved direct reliving of the disaster but inv^
depicted stressful episodes that represented
tions of normal developmental crises such as
tion, abandonment, castration, and guilt (1,8).
The regressive process in these traumatic neurwe
differs from that in other psychoneuroses. The pxJu
not gratification or mastery of infantile conflicts, bw
rather an attempt to work through recent traumu
anxiety. The anxieties of infantile and chiklhuri
phases of personality development become the
of undoing because these problems had been sikci*
fully contained or overcome; dreams of long-pai
stresses that had been mastered provided reassure,-.
to the survivors that they could overcome the r«c*
trauma. Just as “examination dreams” attempt lode*
with anticipatory anxiety by fantasying a past sim*
that had been overcome, dreams that are charade
istic of traumatic neuroses attempt to neutralize th i
overwhelming anxiety of the traumatic event by r«4
ing successful past adaptations to difficult situation*
Each of these phases of dealing with normal tfc*reproduced in the survivors’ dreams, is common
all persons as part of human epigenesis. Each p* j
crisis included not only a deprivation of instinctual*
mand but also a threat to the continuity of lifeter aspect is what makes them particularly suitab*
undoing the threat of annihilation experienced •'
trauma like the Buffalo Creek disaster.
Because undoing relies on omnipotence and
it prevents recognition of the influence of P** I
shameful attitudes toward the self. The
:
ess—aimed at fending off fearful anticipation of a/ |
rence of the traumatic experience—is a conunuuw <
stacle to the relatively nonanxious acceptance <
man vulnerability that is necessary for readapt***
The Psychological Emphasis on Survival
Psychological conservatism consisted
’
of situations that might raise the level of
;
ther internally or externally. Il is the di •
xi
psychological counterpart of the psychic nun
scribed by Litton and Olson (1). We perce'v<
‘
conservation as mental activity designed 10 * 4
havior by banking energies, surrendering am*
during enthusiasm, dampening socializing
d
S
jnd discouraging novel experience (-11). Psyj
conservatism accepts survival as Ihe only
I
j-existence. It is a trade-off: the individual acJ ^'hopelessness in the present to prevent help** inthe future, as if to say, “Better to live withhan not to live at all." Psychological con4
functions as if the disaster . will recur
thus totally distorting an individual's view
’future. If you live as though the dreaded unceris certain to occur, you become a psychic confrtomanizat,on
humanization affects one’s view of life and hurtlationships and has a direct toxic effect on per^jity function. Every disaster places man at the
* of forces beyond his control. The feeling of
Zl a pawn of fate is dehumanizing—people feel
JjJtout appeal, beyond empathy, and cannot be peror assuaged. When the catastrophe is mandehumanization is magnified. In Buffalo <Teek,
5 Mt was
terr^e realization that other human
I kings had planned, built, and maintained an unsound
I iam and then acted irresponsibly and uncaringly after
S & resulting disaster. The defense of dehumanization
sinexample of identification with the aggressor. It deI ^yed pride and joy in being human.
) Dehumanization may be mitigated by corrective exI priences with empathic people in the helping profesHonsand private and public institutions. Collaboration
•rthother sufferers in a law suit against the dehumanizr<aggressor may also be useful in that it can ensure
that it will be more difficult for such organizations to
risk human life in the future.
CONCLUSIONS
his our belief that the reactions we have described
ire not those of individuals with weak egos who were
exaggerating their complaints in order to win a.law
sit. These people, by and large, did not exaggerate
tor complaints; the majority minimized or denied
ton. If their reactions were merely exacerbations of
^neurotic symptoms and problems, we would have
“countered a wider range of psychoneurotic reac
ts. Although there were differences in modes of rethe uniformity of the psychological reactions
^Prising the Buffalo Creek syndrome was striking.
^analyses-of dreams and early memories, reported
"**here (12, 13), support the consistency and sever*10. this syndrome.
'e found a definable clinical entity characterized by
^ll-delineated group of clinical symptoms and
in character and lifestyle that were related to
clear-cut psychopathogenic factors precipitated by the
disaster. All of us have in our unconscious memory
systems encounters with the various forms of dread"
that a disaster reawakens. There need not be any pre
existing neurosis for the Buffalo Creek syndrome to be
come disabling and chronic. All of us are susceptible
to traumatic neurosis and the "death imprint."
To be successful in treating these traumatic neuro
ses, we must substitute active recall and working
through of the painful memories of helplessness and
separation for counterphobic behavior, passive repro
duction of the experience in dreams, and magical ways
of living out and reenacting the trauma. The change
from passive to active experience, from reproduction
to re-creation is the essential thing. By linking longpast and previously worked-through childhood anx
ieties vrith the overwhelming anxieties aroused by the
recent disaster, we may be able to strengthen the ego
of the individual with a traumatic neurosis. Through
his relationship with helping and capable persons and
institutions, the disaster survivor is given an oppunu
nity for regrowth, much like the ego development that
came about as the individual met and dealt with the
normal crises of growing up.
REFERENCES
I. Lifton RJ, Olson E: The human meaning of total disaster. Psy
chiatry (in press)
2. Furst SS (ed): Psychic Trauma. New York, Basic Books. 1967
3. Freud S: inhibitions, symptoms and anxiety (1926), in The Com
plete Psychological Works, standard ed, vol 20. Translated and
edited by Strachy J. London, Hogarth Ptess, 1959, pp 77-175
4. Titchener JL, Ross WD: Acute or chronic stress as determt
nants of behavior, character and neurosis, in American Hand
book of Psychiatry. 2nd ed, vol 3. Edited by Arieti S, Brady EB;
Areti S, editor-in-chief. New York. Basic Books, 1974. pp 39-60
5. Engel GL: Anxiety and depressive-withdrawal. Int J Psychoanal 43:89-97, 1962 .
*
6. Lifton RJ: Death in Life: Survivors of Hiroshima. New York,
Random House, 1967 •
7. Horowitz M: Stress response syndromes. Arch Gen Psychiatry
31:768—7.81, 1974
.
8. Rangell L: A further attempt to resolve the “problem of anx
iety,’’ J Am Psychoanal Assoc 16:371—404, 1968
9. Kemberg O: The treatment of patients with borderline person
ality organization. In’ J Psychoanal 49:600-610, 1968
10. Trunnel! E; Holt W: The concept of denial or disavowal. J Am
Psychoanal Assoc 22:767-784, 1974
11. Luchterhand EG: Sociological approaches to massive stress in
natural and man-made disaster. Int Psychiatry Clin 8:29-53.
I971 •
~ ,
12. Titchenej JL, Kapp FF. Winget C: The Buffalo Creek syn
drome; symptoms and character change alter a miyor disaster,
in Emergency Medical and Disaster Aid: A Source Book. Edit
ed by Purad HJ, Resnik HLP, Parad LG. Bowie. Md, Charles
Pitss. 1975 *
*’•
,
13. Gottschalk LA, Gleser GC: The Measurement of Psyehologual
States Through the Content Analysis of Verbal Behavior. Berke
ley, University of California Press, 1969
Am J Psychiatry 133:3t March 1976
3W
From Chaos to Responsibility
R Y GERA'.D M. STER5. L.L.B.
T.he litigation initiated by the 625 survivors ofthe
Buffalo Creek flood who refused to settle with the coal
company claims office was a landmark case. For the
first time, individuals who were not present at the
scene of a disaster were allowed to recoverfor mental
injuries. Psychic impairment, the term coinedfor
these injuries, was found in virtually all of the
survivor-plaint ijfs. In an out of court settlement, the
sur\ivors were awarded$13.5 million, $6 million of
which was distributed on the basis of a point system as
compensation for the psychological damages.
The destruction of the Buffalo Creek community
gave rise almost immediately to the creation of a new
kind of group—a community of 625 survivors from 160
families who joined together to sue the coal company
that owned the dam. These individuals, unlike the ma
jority of the survivors, refused to settle their cases at
the coal company claims’office. I.! .lead, they sought
legal help outside the state of West Virginia.
This group contacted Arnold & Porter, a law firm in
Washington. D.C.. and we agreed to represent them.1
We immediately went to Buffalo Creek and spent
many days interviewing survivors at Charlie Cowan’s
gas station, one of the few buildings remaining in the
Buffalo Creek valley. Mr. Cowan Was the leader pf the
citizens’ committee that called to ask for our legal
help. 'I he survivors’ legal right to sue for traditional
damages was clear; they could sue for lost property,
for their homes and all their possessions, for physical
injuries, or for the death of family members. However,
it soon became apparent that they also had significant
mental injuries, and it was not so clear whether the law
would permit recovery for these damages.
T he magnitude and significance of these mental and
emotional damages hit me personally when I inter
viewed a coal miner who had lost his 22 . mth-old son
and hi* pregnant wife in the disaster. Th*. ilood waters
caught this family asleep in their home. As the wife dis
appeared in the black water, she cried out to her hus
band to save their son. He held the child tightly and
PjcMrntcd ui the !2sih annual meeting of th? American Psychiatric
A*u.Kiatjon. Anaheim. CaliJ . May $-9. 197.5
Mr Stern h a partner in the Lw firm of Arnold St Porter, 1229 19th
St . S.W., Washington. D.C. 20036.
‘A much more detailed report of my observation* and involvement
in truvcave will be prevented in a forthcoming work (I).
Am J Psychiatry 133:3, March 1976
tried to struggle to safety, but houses and debnjk ■
tered him arid the child as they were Washev
down the valley. Somewhere in this maelstrom, hju
his grip on his son, who disappeared forever into
black waters. Eventually, this man was able £
struggle to safety, although his body was badly 1^
ated by the jagged wood in the water. At the tiriK 1 w
terviewed him, my own son was exactly 22
old% I was terribly upset by his story and decided
to expand the. lawsuit to recover for his mental
and for the mental suffering of others like him.
We contacted Robert J. Lifton, M.D., who had
ied the survivors of Hiroshima. He agreed to inter**
a number of our clients and to help us explain lofe
court in lay terms the common psychiatric injuria4
• these survivors. He also suggested that we ask Dr.b
Erikson, whose findings are reported in this section
study the sociological aspects of this disaster. Wl
these two men as our principal experts, we articuU*
for the court and for the coal company defendant wbd
we called the “psychic impairment’’ damages suffer I
by every one of our survivor-clients.
|
We coined the term “psychic impairment"
I
elude both the psychiatric damages identified by 0
Lifton and the loss of communality found by Dr. M I
son. We wanted to avoid alleging that the suniwn ■
suffered mental illness and felt that the phrase
impairment’* had a less negative connotation.
|
Eventually we also employed a team of psychuin*
. from the University of Cincinnati, some of who* |
ings are also presented in this section, to
each of our clients. The coal company also rcuiw1
psychiatrist—tactually, a physician whose
field was neurosurgery—and a young psycho^
training, who also examined each of the 625 men,**
en, and children involved in the lawsuit.
Our psychiatric studies indicated that almosJ
the survivors were suffering from psychiatric d"
of varying degrees as a result of this disaster, w •
trast, the physician retained by the coal
|
termined that the survivors generally
’
transient situational disturbances that he fe'1
j
have abated soon after the disaster. The f?ct t®* <
survivors still had disturbances when he
them some 18 months after the disaster led hifl
sume almost invariably that these*people
ing primarily from preexisting mental
Under traditional legal principles, if the
had been physically injured by the flood wak ’
a result, had suffered psychiatric damages.
recover full monetary damages unless
k
4
G» P.A! D M. Si I P.N
f
^itions were merely the result of an aggrava^^yrting mental conditions. Our physicians
T..( the
(he survivors'
survivors’ psychiatric damages were
I’
nh;u
by the disaster. The coal company physi^uerecd. This is a dispute juries must often rcinvolving psychiatric damages.
interesting and more difficult legal quesRented by this ease was whether the survivors
' L-covci monetary damages at all. even if the jury
v^[Mt a’l ,hc sl,rv’v°rs' present psychiatric in■-xufre caused by the disaster. Traditionally the
not permit recovery for psychiatric injury on
•* aground that the injury can be proven to have
*^al)sed by another person or persons. For exa mother who secs a truck run over and kill her
’ -(nav suffer severe psychiatric*trauma. but the law
• . ina||V has denied the mother recovery for her
Offering, terming her a mere bystander. Needless
w v an individual who secs a friend killed has even
fiance in the courts of recovering for mental sufI
,n*
.
- .
-
1-------------•
TL
•
I| lathis case. most of the survivors
. were not senousm>ured physically. Many of them had run up the
jfklhe valley just ahead of the flood waters, and
,3foflhem w'ere not even in the valley at the time of
^disaster. For example, one survivor was visiting in
»vi Mexico, another was in Florida, some were in
jid others w-ere in hospitals in nearby tow ns out■ the valley. Nevertheless, we insisted that all of
-csurvivors were entitled to recover for their mental
Jeong, even if they suffered no physical injury, saw
(iitard no relative or friend in peril, or were absent
fithe valley on the day of the disaster. We argued
•jcach resident of the valley, even those who were
mhere during the flood, was a direct victim of the
.^company’s reckless conduct and not merely a byader.
The court agreed with this contention and held that
Jiwvivors—even those who w'ere outside the valley
!• the time of the disaster—could collect for mental in
i
jury if we could convince the jury that the coal compa
ny’s conduct was reckless (i.c., more than merely neg
ligent), and that this reckless conduct caused the survi
vors’ mental suffering (2).
Once the coal company realized that the court would
not dismiss the psychic impairment claims of any of
the 625 survivor-plaintiffs in this lawsuit, we reached asettlement for a total of $13.5 million, to be divided
among the survivors by their own attorneys We first
calculated the payments for real and personal property
losses, for wrongful deaths, lost wages, other miscella
neous claims, expenses, and legal fees. This left ap
proximately $6 million to be distributed for psychic im
pairment. We distributed this money to the 625 plain
tiffs using a point system based on their immediate
involvement with the disaster, their medical disability,
their loss of community ties, and the disruption of their
way of life. Each survivor received between $7,500
and $10,000 after all expenses and legal fees were de
ducted. Approximately $2 million of the $6 million was
placed directly in a.trust fund for the 224 children un
der the age of 18 who were plaintiffs in the case.
The court’s approval of this substantial monetarysettlement for survivors’ psychic impairment estab
lished a significant legal precedent for recovery in cas
es of mental suffering. The court was not bound by con
cepts of space and time. Instead, the court recognized
that it is the permanence of loss, rather than the wit
nessing of the disaster, that causes mental suffering.
In other words, the court (and eventually the coal
company) was persuaded that the relief provided by
the law should be determined not by narrow traditional
legal principles but by fairly modern psychiatric and
sociological principles.
REFERENCES
1. Stem GM: The Buffalo Creek Disaster. New York, Random
House (in press)
2. Pnnce. et al v Pittston, 63 Federal Rules Decisions 28 [SD, W
Va (1974)1
Am J Psychiatry 133:3, March 1V76
301
•A
Loss of Commonality at Buffalo Creek
ttYKAIT. ERIKSON, PH.D.
though distant and hard to relate to. But
The survivors of the Buffalo Creek disaster suffered
er exist as a connected pair or as linked cells inifc? ■
both individual and collective trauma, the latter being
communal body.
Reflected in their loss of communality. Human
The two traumas are closely related, of council
relationships in this community had been derivedfrom
they are distinct in the sense that cither of them^l
traditional bonds of kinship and neighborliness. When
take place in the absence of the other. For install
forced to give up these long-standing ties with familiar
person who suffers deep psychic wounds as thertm
places and people, the survivors experienced
of an automobile accident, but who never losnc*
demoralization, disoriahtation, and loss of
tact with his community, can be said to suffer from
Connection. Stripped of the support they had received
dividual trauma. A person whose feelings of wclk^
from their community, they became apathetic and
begin to wither because the surrounding community
seemed to have forgotten how to care for one another.
stripped away and no longer offers a base of supfu>
This was apparently a'community that was stronger .
(as is known to have happened in certain slumclu
than the sum of its parts, and these parts—the survivors
ance projects) can be said to suffer from coIIku
of the Buffalo Creek flopd—are now having great
trauma. In most large-scale human disasters
difficulty finding the personal resources to replace the
course, the two traumas occur jointly and arc cip»j
energy and direction, they had once found in their
enced as two halves of a continuous whole. For 11
Community.
purposes of this paper, however, it is worthwhile * II
sist on the distinction at least briefly, partly tawtil
alerts us to look for the degree to which the psytM
impairment observed in settings like Buffalo CrtcUn
The trauma experienced by the survivors of the Buf
be attributed to loss of commonality, and partly h |
falo Creek disaster can be conceptualized as having
cause it underscores the point that it is difficult V
(wo related but distinguishable facets—the individual
people to recover from the effects of individual
trauma and the collective trauma.
when the community on which they have depended** |
By individual trauma, I mean a blow to the psyche
mains fragmented.
j
that breaks through one’s defenses so suddenly and
I am proposing, then, that many of the inw«*|
with such force that one cannot respond effectively.
symptoms experienced by the people of Buffal-'Cf* j
As the other papers in this section make abundantly
are as much a reaction to the shock of Isepan* •
clear, the Buffalo Creek survivors experienced just
from a meaningful community base as to the acn» J
such a blow. They suffered deep shock as a result of
their exposure to so much death and destruction, and • saster itself.
It should be noted that “community”
they withdrew into themselves, feeling numbed,
more in Buffalo Creek than it does in most other f
afraid, vulnerable, and very alone.
By collective trauma, I mean a blow to the tissues of of the United States. Much has been said in tl*
j
social life that damages the bonds linking people to ture on Appalachia about the importance
and neighborliness in mountain society.
gether and impairs the prevailing sense of commutrue that coal camps like the ones along Buffaw i
nality. The collective trauma works its way slowly and
even insidiously into the awareness of those who suf differ in many ways from the typical Appalachuu> .
munity, the people of Buffalo Creek were no* !
fer from it; thus it does not have the quality of sudden
joined together in the close and intimate bonds
.
ness usually associated with the word “trauma.” It is,
ciologists call gemeinschaft. The rhythm* of * k
however, a form of shuck—a gradual realization that
life were largely set by the community in
J
the community no longer exists as a source of nurturgoverned by long-standing traditions, and l , |
ance and that a part of the self has disappeared. “I”
linkages by which people were connected * . J
continue to exist, although damaged and maybe even
strong. In Buffalo Creek, tightly knit commuw^ <
permanently changed. “You” continue to exist, alwere considered the natural or<|er of thing*u
lope in which people live.
•
Long stories must be made short in a
,
Presented al lhe 12Xih annual meeting of the American Psychiatric
Assuciaimn, Anaheim, Calif.. May 5-9. ,975.
like this, so I will simply summarize my
ing that the human communities along
Dr. bxtksun is Professor of Sociology and Chair, American Studies
Program, Yale University, New Haven, Conn. 06520.
were essentially destroyed by the disaster
;
A/ri J Psychiatry 133 J. March 1976
' 'i
I
rhe neod ilsc,f forcc<1 thc residents of the hola number of nearby refugee camps from
’’ bite) wcrc’ f°r a varicly °f reasons, unable to e.sresult was that the majority of thc Buffalo
\\ijrvivprs remained in thc general vicinity of
• jj homes, working in familiar mines, traveling
miliar reads, trading in familiar stores, attendiliar schools, and sometimes worshipping in faChurches. However, thc people were scattered
^'^less at random throughout thc vicinity—virtu^tranded in the spots to which they had been
i by the flood—and this meant that old bonds of
'hip and neighborhood, which had always dependfxi physical proximity, were effectively severed.
no longer related to one another in old and ac^■xnfd wavs. The threads of the social fabric had
year after the disaster (which is roughly when
of the authors represented in this section first enuntered these people) visitors to Buffalo Creek were
^khy a number of behavioral manifestations that
iefined to be exhibited by almost everyone in the valand, for that matter, continue to this day. Se 'eral
/these manifestations are discussed elsewhere ii< this
urtion. I would like to mention three by way of illus
ion^ a larger point.
IMORALIZATION
First, the survivors clearly suffer from a state of sedemoralization, both in the sense that they have
irtmuch personal mo-ale and in the sense that they
hive lost (or so they fear) most of their moral anchors.
The lack of morale is reflected in a profound apathy,
• feeling that the world has more or less come to an
ad and that there are no longer any sound reasons for
Axng anything. People are drained of energy and con•xticn, not just because they are still stunned by the
*vagery of the flood but because activity of any kind
wmstohave lost much of its direction and purpose in
absence of a confirming community surround.
Mfeel that the ground has been pulled out from um
kthem, that the context in which they had worked,
tyed, and cared for others has more or less dis‘tycared. One survivor said.
•don’t know. I just got to the point where I just more or
don't care. I don’t have no ambition to do the things I
^todo. 1 used to try to keep things up. But anymore I
Wdon i. h seems 1 just do enough to get by, to make it
more day. It seems like I just lost everything at
^•like the bottom just dropped, out of everything.
cbnical term for this state of mind
. **depression, but one can hardly escape the ims’pn that it is, at least in part, a reaction to the ampostdisaster life in the valley. The survi'4er’a,,y oul °f place and uprooted. They had
realized the extent to which they relied on the
I
I
rest of the community to relied a sense uf security and
well-being, or how much lhey depended on oihcrs ro
supply them with a point of reference.
The people of Buffalo Creek a.c also haunted by a
suspicion that moral standards arc beginning to col
lapse all over thc valley, and in some ways it would
appear that they are right. As is so often the case, the
forms of misbehavior people find cropping up in their
midst are exactly those about which they arc most sen-.
sitive. T he use of alcohol, always a sensitive problem
in Appalachian society, has apparently increased, and
there arc rumors everywhere that drugs have found
their way into thc valley. The theft rate has also gone
up, and theft has always been viewed in the mountains
as a sure index of social disorganization. The crudest
cut of all, however, is that younger people seem to be
slipping away from parental control and are becoming
involved in nameless delinquencies. This is an ex
tremely disturbing development in a culture so de
voted to the family and so concerned about generation
al continuity.
This apparent collapse of conventional morality has
a number of curious aspects. For one thing, observers
generally feel that there is much less deviation from
community norms than the local people seem to fear.
Moreover, there is an interesting incongruity in these
reports of immorality—one gets the impression that
virtually everyone is coming into contact now with per
sons of lower moral stature than they did formerly.
This, of and by itself, does not make very much logis
tical sense. One survivor said flatly,
•
The people of Buffalo Creek tended to group themselves
together; therefore the breaking up of the old communities
threw all kinds of different people together. At the risk of
sounding superior, I feel we are living amidst people with
lower moral values than us.
•
Perhaps this is true—but where did all these sordid
people come from? .Whatever else people, may say
about their new neighbors, in the refugee camps, they
are also from Buffalo Cheek, and it is hard to avoid thc
suspicion that their perceived immorality has as much .
to do with their newness as with their actual behavior.
It may be that relative strangers are almost by defini
tion less “moral” than familiar neighbors. To live with-’
in a tightly knit community is to make allowances for
behavior that might -btherv/ise look deviant. New
neighbors do not qualify for this clemency—not yet, at
least—-and to that extent, their very unfamiliarity may
seem to hint at vice all by itself.
The collapse of morality in Buffalo Creek thus seems
to have two edges. We.have sufficient evidence to believe that certain forms of deviation are actually on the
increase, although thi's’is a difficult thing to measure ac
curately. 'However, we also have reason to believe
that the breakdown of accustomed neighborhood pat
terns and the scattering of people into unfamiliar new
groupings has increiised the level of suspicion people
feel toward one another.
Am J Psychiatry 133:3. March IV76
303
I
For better or worse, the people of the hodJi •
The people of Buffalo Creek are also clearly suffer deeply enmeshed in the tissues of their
J
ing from a prolonged sense of disorientation. It has of
they drew their very being from them. When th?? f
ten been no’cd that the survivors of a disaster arc like
sues were stripped away by the disaster,
• *
DISORIENTATION
connection—a sense of separation from other *-■»
ly to be dazed and <unned, unable to .locate them
themselves exposed and alone, suddenly
selves.meaningfully in tirnc and space. Time seems to
their personal resources. The cruel fact is th^ F
stop for them; places and objects suddenly seem transi
the survivors proved to have few resources
tory. They have trouble finding stable points of refer
cause they lacked the heart or the competence,
ence in the surrounding.tcrrain. both physical and hu
cause they had spent so many years placing the*
man. to help fix their position and orient their behav
ties in the service of the larger community that^
ior. Ail of this can be understood as a natural
did not really know how to mobilize them for the**,
consequence of shock, but the people of Buffalo Creek
purposes.
seem to have continued to experience this sense of dis
Many people feel that they have lost meaningful^
location for months and even years after the crisis.
nection with themselves. Much of their ipp**
“Wc find ourselves standing, not knowing exactly
former strength was actually the reflected strength
which way to go or where to turn,” said one individ
the community, and they are learning—to their
ual. Another survivor noted,-“We feel like we’re living
grqat discomfort—that they cannot maintain an eafe
in a strange and different place, even though it is just a
ing sense of self when separated from that larger t
few miles up Buffalo Creek from where we were.”
sue. They find that they are not very good1 at
at
Professional observers who have gone into the vaL
individual decisions, getting along with others, or*
Icy on medical or research errands have noted repeat
tablishing themselves as separate persons in the 4
edly how frequently .the survivors seem to forget
sence of a supportive surround. “Lonesome” bi|
simple bits of everyday information—the names of
word many of them use, and they do not use it to m* j
close friends, their own telephone numbers, etc. . the lack of human company. One woman who to f
People are often unable to locate themselves spatially,
moved to the center of a large neighboring, town ud*
even when they are staring at' fixed landmarks they
her new home: “It is like being all alone in the iruM
have known all their lives. It is not at all uncommon
of a desert.” A man who continued to live in his J*
for them to answer factual questions about time—their
aged home on Buffalo Creek said,
own age or their children’.s grade in school—as if histo
Well, there is a difference in my condition. Like **
ry had indeed stopped on the date of the disaster. In
body being in a strange world with nobody around I*
general, people all over the valley live with a lasting
don’t know nobody. You walk the floor or look for**
sense of being out of place, disconnected, and tom
body you know to talk to, and you don’t have nobody
loose from their moorings, and this feeling has far out
lasted the initial trauma of the catastrophe itself.
In addition, the inability of people to come to |
People normally learn who they are and where they
with their own individual isolation is counterpart*
are by taking soundings from their fellows. As .if em
by an inability to relate to others on a one-to-one
J
ploying a subtle form of radar, we probe other people
Human relations along Buffalo Creek took
J
in our immediate environment with looks, gestures,
and words, hoping to learn something about ourselves • from the expectations that pressed in on them tn* l
all sides like a mold: they were regulated by thee*!
from »he signals we get in return. But when there are
10ms of the neighborhood, the ways of the comnw* |
no reliable objects off of whom to bounce those explor
and the traditions of the family. When that nKW*l
atory probes, people have a -hard time calculating
stripped away, long-standing relationships
j
where they stand in relation to the rest of the world. In
to disintegrate. This is true of everyday acquaint^ |
a very real sense, they come to feel that they are not
but it is doubly—and painfully—true °CmarT'^l
whole persons, not entirely human, because they do
Wives and husbands discovered that they did not r
not know how to position themselves in a larger com
how to nourish one another, make decisions. ** ,
munal setting.
to engage in satisfactory conversations
community was no longer there to provide •c
Well, I just don’t feel like the same person. 1 feel like 1
and set a rhythm. There has been a sharp * &
live in a diflerent world. I don’t have no home no more. 1
in the divorce rate, but that statistical
don't feel normal anymore. 1 mean, sometimes I just won
not begin to express the difficulties the
der if I’m a human being. I just feel like I don't have no
have relating to their spouses. It is almost as
j
friends in the world, nobody cares for me, nobody knows
be
9
I even exist.
LOSS OF CONNECTION
A third manifestation.of the disaster’s psychosocial
effects is a condition that might be described as Joss of
nal forces of one sort or another had knit
.
together by holding them in a kind of
!
field, but when the forces of that field
f
sipatc, family members became scattered ld£
individual particles. Each individual
yt
own hurts and tends to his or her own busn*5* |
■
304
A/w J Psychiatry 133J, March 1976
w how io care for one another or lo-coordir1* <
because the context that lent subnd meaning to their relationships has disJ Two survivors put it this way:
. person in the family is a loner now, a person
Each of|,s ,s fighting his own battles. We just don’t
* \ ' -re lor each other anymore.
farmly*s no1 w^at they was. They’re not the same
fi* I
know how you’d put this, but before there
c in the home. But now it seems like each one is a
’< 'ni person, an individual by himself or herself, and
^Xjust nothing there.
r J]y, the difficulty people experience in sustaining
^relationships extends beyond marriages and fam’^out into the rest of the valley. In places like BufVpreck, relationships are part of the natural oriLbeing inherited by birth or acquired by physical
dimity-and the very idea of “making” friends or
relationships is hard for these people to unand harder still for them to achieve.
O result of all the problems I have described is
uiihe community (what remains of it) seems to nave
its most significant quality—the power it gave
to care for one another in moments of need, to
Cleone another in moments of distress, and to pro
pone another in moments of danger. In retrospect,
it is apparent that the community wa< indeed stronger
than the sum of its parts in this regard. When the.
people of Buffalo Creek were clustered together in the f
embrace of a community, they were capable of remark
able acts of generosity; when they tried to relate to
one another as separate individuals, they found that
they could no longer mobilize the energy to care. One
woman summed it up in a phrase: “It seems like the
caring part of• our lives
is gone.”
«
•
•
CONCLUSIONS
To end with an oversimplified metaphor, I would
suggest that the people of Buffalo Creek were accus
tomed to placing their individual energies and re
sources at the disposal of the larger collectivity—the
communal store, as it were—and then drawing on
those reserves when the demands of everyday life
made this necessary. When the community more or
less disappeared, as it did after the disaster, people
found that they could not take advantage of the
energies they once invested in that communal store.
They found themselves almost empty of feeling, devoid
of affection, and lacking all confidence and assurance.
It -is as if the cells had supplied raw energy to the whole
body but did not have the means to convert that ener
gy into usable personal resources once the body was
no longer there to process it.
Am j Psychiatry 133:3, March 1276
305
Children of Disaster: Cfinical ObseFwarionstakEafifaiofereek
BY C. JANET NEWMAN, M.D.
Most of the 224 children who were survivor-plaintiffs
of the Buffalo Creek disaster were emotionally
impaired by their experiences. The major factors
contributing to this impairment were the child's
developmental level at the time of the flood, his
perceptions of the reactions of his family, and his
direct exposures to the disaster. The authorfocuses on
children under 12, describing their responses to
jantasy-eliciting techniques and "their observed
behavior after the flood compared with developmental
norms for their age and reports of their previous
behavior. These children share a modified sense of .
reality, increased vulnerability to future stresses,
altered senses of the power of the self, and early .
awareness offragmentation and death. These factors
could lead to ‘ after-trauma” in-later life if they
cannot make the necessary adaptations and/or do
not receive special help to deal with the traumas.
As part of the psychiatric evaluation of the survivors
of the Buffalo Creek flood, 224 children were inter
viewed and evaluated; most were found to be signifi
cantly or severely emotionally impaired by theirexperi-
the nature of the disaster, and the meaning of the k
suit.
We used such fantasy-eliciting techniques «
wishes,” “draw a person,” and story telling, k
adolescent children were asked to draw a pktwt^
the flood as they remembered it. Special
from the Children’s Psychiatric Center obuhw
school data to confirm or correct parental impm^a
of major losses of academic achievement dui p
sisted long after the disaster. .
The effects of the disaster on children can be mi
uted to three major factors: 1) their developmentilfc
el at the time of the disaster, 2) their perceptions of
family’s reactions to the disaster, and 3) their directs
posures to the disaster. This paper illustrates e^chfe
tor and examines their numerous interactions.
DEVELOPMENTAL LEVEL
The developmental factor will be illustrated
trusting the clinical evidence gathered from 3 birt
age children and 2 preschoolers. A depressed, top
less, and guilt-ridden 11-year-old boy who haddix*
ered human remains in his immediate environment^
enccs during and after the flood. In this papei 1 will fo
ter the flood drew a starkly realistic picture of a
cus on children under the age of 12, using as a sample
11 c.f the children I assessed personally.
As has been described elsewhere in this section, the
evaluation procedure began with an interview of the to
tal family and proceeded to individual interviews. In
interviews of mothers, outlines of each child’s devel
opmental history and functioning before and after the
disaster were obtained. This information was passed
on to the child psychiatrists in order to help us place
each child in his parents’ developmental perspective.
Children were usually seen in their own rooms. They
were encouraged to recall-the. r own experiences of the
flood; such expressions had often been submerged or
inhibited amidst the outpourings of more vocal family
members. The issues we discussed included past and
present family life, personal feelings, school experi
ences, and the childrens’ perceptions of future hopes,
ment. A 7-year-old child also indicated
•
• •
Hrvucd version of a paper presented at the 12Kth annual meeting of
the AriiciK'An Ps)chiutnc Association, Anaheim. Calif May 5-9,
1975.
Dr Neuman is Director, Day Hospital Elementary Unit. Children's
Psjchiatnc ('enter. 3140 Haney Ave.. Cincinnati, Ohio 45229. and
Assoculc Profcsso’ of C hild Psychiatry. Department of Psychiatry.
University of Cincinnati College of Medicine.
306
Am J Psychiatry 133:3. March
pletely submerged trailer that contained i -o pef
screaming for help. A house above the trailer****
filled with water, and a panic-stricken figure tri**
keep afloat amidst the waves and debris of the ■*
waters. Drawings by 2 younger children showed
sible symbolic meaning of mountaim to
children, i.e., the provision of humanlike funct**
cradling and life sustenance (this contrasts with L*
and Olson's remarks about the “overall cm in
including nature itself, as threatening and lethal
An 8-year-old boy with a chronic anxiety
drew the “house-mountain”- depicted in
life-saving compensation for his temporarily
helpless parents. The drawing represents a
,
regression to a wishful merging of parental sec •
to a house-mountain in a partially beneficent c
ture in a picture of himself climbing a
his mother and aunt. He drew a tree J*
saying, “This is a tree 1 can hang onto if I
Nature offers support when human
seem helpless. In Appalachia, the mountain*™^
not only slag heaps and flood threats but tan*1
suring security.
< . J A NI-. I
•« Drswinf of b “HouM-Mounl
M M the tnitef H destroyed, white the i*<e “mountain" acquires door
Tk experiences of 2 younger boys will be described
ioisolaie developmental factors at the preschool level.
-ry, who was 3 years old at the time of the disaster
aJ5at the time of our interview, was the only son
jrJfavorite child of his mother’s second marriage. He
[.a the first to awaken on the morning of the flood.
looking out his window, he viewed the uncanny and
Kiplcxing sight of a house moving down the creek.
Insure whether this was real or a dream, he awakened
taparents, conveying more cognitive bewilderment
iwfright or anxiety. He remembered saying. “Come
ndlook!” The parents rose instantly and managed to
'‘Kiiate the family to safety on high ground just in
tat.
Two years after the flood, his mother told us that
.kwy frequently slept in the same bed with her and
<sed to be rocked, although he had rarely needed this
^ofattention before the disaster. She reported that
Softer talked about the houses and cars that had
by in the flood md how they “went boom!” 1
’hiit because Henry was the first to awaken and. in
rescued his family, they regarded him with
gratitude and admit ttion. During the family in'** Henry v as hyperactive—he was friendly but
bis individual interview, he recalled seeing
. • * Koing by his window anu asking his parents •
^e and look. Hi denied being scared, but said, “I
v ''ke it.” Henry also remembered seeing a
?ll,l8 baby on top of an upside-down store that
downstrv im. He said, “1 didn’t like that
1 bated it.”
^2??
picture started with a creek as an alVvl circle. Then a curving line showed “how
NEW MAN
the creek goes here.” A tounded object near the path
of the flood conveyed its force: as he explained. ’The
flood threw this lock.” Then Henry spontaneously
drew a 3-sided rectangular but bottomless form nearby
with “windows” for eyes, explaining th it this was a
person killed in the flood. Most children Henry’s age.
drawing their first human figures, use crude < ircies for
heads or hcad-and-body combinations, in a precirclc
piiase they use primitive scribble-strokes to indicate
human figures. Henry had already manifested a capac
ity for drawing circles but had applied this skill only io
his representation of the flood, using a bottomless rec
tangle with windows for eyes as a human figure. Such
faces or human figures were interpreted as con
densations of humans with buildings, stimulated by
this 3-year-old’s view of a peculiarly and perhaps
awesomely floating house and other buildings, includ
ing the one the screaming baby was on. His flood expe
rience started as he awakened from sleep, and sorting
dream I rem waking perception and reality is typically
difficult for young children. Developmentally. Henry
was at a stage of tenuous differentiation of dream from
reality and animate from inanimate objects, and motil
ity is the first characteristic differentiating living from
inanimate objects.
• To summarize, Henry’s drawing showed the human
figure as dehumanized and fused with a seemingly ani
mated building. The bottomlessness of the human
face-figure suggests his lack of security, which was
shown clinically by hyperactivity and an excessive
need to be closer to his mother than he had been befoie. The circular flood moving huge rocks suggests
the projection of superhuman powers to nature. His
barely developed abilities to separate animate from in
animate and actuality, from fantasy or dreams help ,o
explain his current bewilderment, excessive anxiety,
and hyperactivity. His favored position in the family
and his role as “rescuer” have accentuated his sense
of narcissistic omnipotence, which allays his under
lying feelings of helplessness and anxiety. It is likely
that his problems of immaturity, anxiety, and devel
opmental deviations in cognition will become more evi
dent when he starts school.
Peter was interviewed 2 years after the disaster,
which occurred when he was 26 months old. His par
ents reported that he had been a happy baby, devel
oping at normal rate. His father, a chronically disabled
miner, described how tfie family scrambled un the side
of the mountain behind their home and watched as
their house was swept away and a nearby bridge crum
bled from, the force of the flood. A frantic passerby
yelled lo Peter’s father to aid in the rescue ol two chil
dren clinging to a floating mattress. As he ran to help,
his wile screamed lor him lo come back. Realizing the
danger, he ran back to his own children and led.them
to higher ground, canying Peter on his chronically
weak back.
Since the disaster. .Peter cannot take a bath without
screaming, and ne stfil wets the bed frequently and
screams in his sleep. He gels mad easily and always
tAcd <4.
Am .1 /‘sychiutry
\f<trch l'>76
wants his own was Peter's memories of the Hood invrd.cd concerns over the *afety of his triends and an
older brother s loss of his best friend. He referred to
the “two kids on a mattress” and worried aloud wheth
er “their daddy, he rrpght j<st not want them.” This
must l»ase represented his own fears at the hands of
his nun father, uho did not sav'e all children, limiting
his efforts to the rescue of his, own family. When
asked about troubles or worries he said, perhaps stoic *Hy. "I don’t be sad*, that’s all." When asked what
would make him happy he said. “I don’t know, maybe
if my daddy was handy."
Peter’s response to the threc-w-ishes question was
torching and highly original and was probably related
to a 4-ycar-old’s determination to ho|d on to reality,
with a resulting fear .of pretending, even for a mo
ment: “I don’t wish.1’ he said proudly. His drawings,
made at age 4. about his flood experience when he was
2 years old. should remind the reader of Henry, who,
although he was perfectly capable of drawing good cir
cles. drew a person aS a house with a rectangular botto nlcss face. Peter, although younger, is involved
w itli deeper, more sophisticated, more human views of
the disaster.
Peter’s first flood" picture included irregularly round
or os al outlines of what he then chose to call win
dows—an "ugly" window, a ‘‘shoe" window, and a
"big" window. (Windows with views of the creek be
came highly important for many families.) As an after
thought. Peter drew a longer shape and told me to
write “two kids on a mattress in the creek" within it. I
then said. "Let’s do that one again on a bigger page."
Peter drew a mattress and started to draw he 2 childien in the fo»m of lines. However, in the process, he
appeared to convert the children into 2 legs (one bare
foot and one with a shoe)’ and then drew a body and a
head labeled "top." creating a total human figure. He
was influenced by the fact that his siblings were draw
ing people. Figure 2 is Peter’s second drawing: the
writing is that of the interviewer during the process of
drawing and records Peter’s words. This is a powerful
Condensation of a traumatic scene, combining his fa
ther’s failure to save all of the endangered children,
particularly those on the mattress. These 2 children be
came the 2 legs of the larger total human figure in the
picture. As with Henry, we see a variety of serious de
velopmental interferences and emotional distortions in
the development of perception and cognition as mani
fested in body image concepts.
FIGURE 2
A 4-Yeaf-OkTt Picture of Two Lost Children Condoma
thre Human Figure
REACTIONS base dos direct flood
experiences
*
Mane was the cute, articulate daughter of a strong
Uiher aid a dominating hypertensive mother; she was
b years eld a! the tunc of the disaster. During the flood
‘Mmuj
«•«■/< hurcfua< or fuif burcfuui in the ch-ape from the
maaJI uitJ feutJcixU trvHhac.
Am J
/JW, Masth M6
Marie's mother bundled her in blanket*
her to shelter, never allowing the child to
stages of the flood.
During Marie's interview, her “druw-a-f*0^
>
••
C. JANET NEWMAN
smiling’ childlike parents in flowered cloth*<3, f’o.vi picture, drawn from hearsay,-seems
4 ‘^-at firs1 glance. However, the bubbly clouds
were duplicates of the‘floral prints of the fa\ ,‘»jrtand the mother s sk:rt in the draw-a-person
The houses stood high above the languid
^nd the many bodies appeared mostly in chcerpositions. Only 2 small figures yelled,
Marie exemplifies a child reacting to maternal
lies, reminding us of the children described by
Freud and Dorothy Burlingham in War and Chilwho reacted far more strongly to maternal
than to bombs.
% major clue to the anxieties underlying the faL of pollyannarsh denial was Marie’s response to
Deepen Bird Fable, which elicits a child's story of
Hi baby bird who can fly a little will do if a strong
blows the family nest from the tree, scattering
fDOther and father and baby bird. Marie asked,
Merc they all close together or were they far apart?”
Ii^nsaid, “What do you think?” Marie replied,
Mother makes another nest, with twigs, on a sliongcr
^ch. The little bird grows up to have a famih Or,
juybe the mommy bird might get sick or die, or a cat
aught cat her Or maybe the little bird might get sick or
po.soned. It might mistake weed-killer for seed. That
ow/t/happen. Oh well, the hl lie bird probably got old and
then died.
.
1ms story reveals a rapid descent from superficial
fcilth into violent and even paranoid ideation, injiving the death of both mother and baby by violence
ad poison. This rapid weakening of defenses reveals
Mine’s vulnerability to and identification with a chronuHy anxious mother, whose exacerbated anxieties
ic had been intimately exposed to in the apparent
mice of being protected herself.
Richard, who was IVi years old at the time of the diwas the middle child of 3, born to mature.parcMi.On the day of the disaster, as soon as the water
r'dfell, Richard and his father searched for relatives.
Vy were concerned about the safety of Richard’s
sister, who had stayed overnight with a girl
tad. The sight of the mutilated body of a boy Rich- ’
was shocking to both the child and his father.
was described as a changed boy siince the
| *4. having become tense, nervous, talking little to
^parents, and suffering from terrifying nightmares of
I
coming back from the black water to take
|
spirit world. When interviewed, he said that
s.ept with a blackjack under his pillow.
I khard's flood picture conveyed a firm sense of
3 slron8 sensc of form combined with creative
drew a truck carrying 5 bodies wrapped
L ,s» set against a background of a burning slag
I
a house with a large chunk missing. The sky
L °'frcast and it was raining. His draw-a-person picimh ^Ver» pruning, colorful comic book character
1
Profile, hows color, movement, and detail
^nd indicates creativity and ego strength. Despite en
during strengths in peer relationships, good school"per
formance, and basically warm family tics, Richard has *
a chronic traumatic anxiety reaction manifested bv
trembling hands, tension, inner tremulousness, diffi
culty sleeping, and nightmares. In contrast to Marie.
who looks deceptively healthy and self-assured but
whose reawakened inner problems stem from close
ambivalent ties to a chronically anxious mother. Rich
ard’s symptoms represent more purely a chronic overt
traumatic reaction to the disaster, in the context of
considerable ego strength.
David, 7 years old during the flood and 9 when inter
viewed, was apparently well-adjusted before the disas
ter. Afterward his grades fell, he tended to keep to him
self, and got into fights. His most severe symptoms,
however, were crying in his sleep, sleep-talking
(saying he wants to “get home again”), and somnam
bulism—he seems to be walking out of the house. Al
though others direct him back to bed,’he docs not
wake up during these episodes but appears frightened.
Since the disaster he has been wetting his bed several
times a night, something he did not do previously
In his interview he appeared attractive and coopera
tive but quiet and somber. He did not recall the con
tent of his sleepwalking episodes, although he vividly
remembers people screaming while they were drown
ing during the flood. David drew a bizarre person with
a strange colorless face looking backward and a bright
ly multicolored body with feet pointing in tl.e opposite
direction from the face (figure 3). Diagnostically, he
had symptoms of a traumatic neurosis with a dis
sociative-type Hysterical neurosis (exemplified by his
somnambulism) encapsulated within it. Il seemed like
ly that his trancclike sleepwalking was a repetition of
the original escape; this interpretation was supported
by his grotesque .drawing of a person whose profile,
while colorless, had a fixed smile and slightly quizzical
or puzzled eyes. Facial distortions and poor fit to the
body are evident in the picture.
David’s pathology Was focused and severe. Sleep
walking usually occurs in stage 4 sleep when central
nervous system motoric inhibition of REM dreams
cannot occur (3). Certain types are called “somnambu
listic trances” and may" represent physical reenact
ments or abreactions pf traumatic situations (4). Da
vid’s bizarre picture suggests an unconscious con
nection between his sleepwalking slate and his
conscious imagery.
Marie has become subtly but severely traumatized
through her direct relationship with a chronically anx-z
ious and flood-traumatized mother, while Richard and
David’s more conspicuous and overt traumatic reac
tions stem more directly from iheb flood experiences.
The contrasts in the syrpplom choices of Richard and
David are probably multiply related to their constitu
tional backgrounds, developmental experiences pre
ceding the trauma, and the exact circumstances of the
moment of greatest trauma
each
experienced
in
the
di*
sasler.
Am J Psychiatry 133 3, March /9M
3<j9
,O«l.r>„.N nF DfSASTf R
r*cvRt 3
A'S TMr-OfTt Dmmg Thorf Sufgcrts a Link Batwwn Hit Somnambv/«v*n W Cotttciout Imajriy-
OBSERVATIONS ON OTHER AGE GROUPS
I have not mentioned another croup of
'
those who were in utcro during the flood. Often
preciousness lies in having survivedtht pregnane-, 7
frantic mother. Among their future stresses maj
never-ending tales oi the silent allusions of thcf>A
about the disaster these children nc»er expend
The parents may sec them as magically an J profott^
linked with the flood. These children, as wcl,«^|
born later (who will also feel left out. yet involved)
be unprcdictably but importantly influenced by
tastrophe.
■
Although this paper has focused on preadokxw
children, a few words must be said about adokxnft
special vulnerabilities to the psychological effects
the disaster. Because the almost tota* community#
struction, the loss of communality described th
where in this section by Dr. Kai Erikson. wasv>fc
ruptive, especially to adolescents, they often I#
to choose between rebellious predelinqucnt I dun
or compliant social withdrawal. They suffered dec;
but privately when their parents broke dawn un#
stress. For example, in one family, the favored oV
brother, who had been the “good one’’ before the I
saster, changed his behavior markedly—he misvdd
days of school, threatened the teaching staff, win »|
pended five times, and is currently on probation
cause of his behavior. At home he sat up at night jppt«
hensively listening to rain or roared away on hixnw J
cycle. However, his next younger brother contim*!
to attend school regularly and made every effort lot 5
centrate. The contrast between his very cfauufcq
picture and a carefully drawn pink dove of peace <
his teacher had praised as “best in the class”
the range and conflict of his inner experiences. wW r
he has internalized, but with unknown enwtuH
strains.
a
Creative expressions emerged in many cases8
a highly disturbed large family living in lwotr."knd
a state of chaos came a touching picture
?
li-year-old boy (figure 4). Denying the turbuk*< k
the flood, he drew an intellectually complex
with excellent perspective that showed a treMie.
intersections, and a quiescent creek. He labels |
“(he road to where we used to live.” In
|
ground, brightly colored idyllic homes in
and orange nestled among the woods on the
There were no people in the picture, but
possibilities for human reconstruction. The th**
matically split roads suggest important chux’0" k
made, and the colorful homes in the backgr^* r
gest hope.
"
Finally, some older children did folio* *1*
and psychiatric interviews with' great
tf
phistication. They recounted hopes of being
and nurses, even though they were often
*
lems in their basic school courses. They
on safety regulations and dam construction*’ j
projects and tried to master their experieacr
I
310
Ap: J Pmfaatr) I3J:J. March 1976
Picture Drawn by an 1!-Year-Old Child
•ti’ .’jRi s OP
ally and ’ntcllcctually. 1 hey will never forget this expe' . ve. and they u ill be vuuchful of all (he adults who
hr v :\.;iicjpated in it: 'hey cither idealize or are disiJb.j’-. -■?<: vuth parents and other adults. When they
grow bp. they will w^ch th? world closely. They will
have learned cnormouslv* both in
• and out of school.
CONCLUSIONS
Children in traumatized families within a shattered
community form their own theories of a disaster from
’heir cun reactions and their perceptions of the reac
tions of their parents and other adults. Their concep
tions arc also influenced by the social, and legal proc
esses associated with Jhe disaster. All of these factors
permanently affect their sense'of self in growing up.
7 he common heritage of most children of disaster is a
modified sense of reality, increased vulnerability to fu
ture stresses, an alt-cred sense of powers within the
self, and a precocious'awareness of fragmentation and
death. In contrast to most of their parents, some of the
children manifested clear and enduring ey*u (
hopefulness and creativity, despite
limitations- in their ability to achieve sptxifc
Their sense of hope existed side-by-side wi'S 4
signs of developmental limitations and serioujJ^I
gy. Indeed, the widening discrepancies betw^
sensitivities and academic achievement could
J
severe “after-trauma” in later life. They wouldr * *
unusual life adaptations or special help to
structively or creatively to thelraumas they had^i
gone.
REFERENCES
1. Lifton RJ, Olson E: The human meaning of
fci
chiatry (in press)
1
2. Freud A, Burlingham D: War and Children. New Yortbf
Willard. 1943, p 21
I
3. Kates A (ed): Sleep Physiology and Pathology. PhiU&tfcj|
Lippincott Co, pp 111-112
'*
4. West LJ: Dissociative reaction, in The Comprthetojw U|?
book of Psychiatry. Edited by Freedman AM, KapUalU.li J
more, Williams & Wilkins Co, 1967, pp 88M99
[
^U89ion of the Buffalo Creek Disaster: The Course of Psychic
^gAM^LL’MD-
, ^cific contribution of the psychiatrist to the
fiudyofthc human disaster at Buffalo Creek
the course ofpsychic trauma. The initial
^intrusion by the flood waters was followed by a
phase of the traumatic cycle, the physical
Ration of the survivors, with disruption of their
rf' and “surround.' ’ During this long
fluent period the level of trauma did not recede
^\(pi rising, although at a slower pace. Distant
^uoflhi trauma may succeed the more immediate
,ri Thefinite psychic space of the survivors is
coached upon by traumatic memories for an
^finite period of time, leaving fewer resources
stablefor normal effective living. The absorption
d merging of traumatic stimuli into a traumalophllia
still another potential p oblem. The
.^ecedented legal decision as to the linear effects of
wellie trauma on a succession of connected
y'duals will needfurther interdisciplinary
jrfication.
'offering opinions on the overwhelming hu-
'dcxperience of the Buffalo Creek disaster, the chal456 reactions
North Carmclina
Ave.,
Losand
Angeles,
flpis o separate
our
of empathy
horPsychoanalytic
Association..
Address
reprint
which,
Liftonofand
Olson
have pointed
out,
* t ‘nJ? as
■ • School
Medicine,
andII]
immediate
Past President
wquickly and painfully shared by all mental health
Psychiatry,
University
of Califor■’tfessionals whokrofessor
came toofthe
valley after
the disaster)
the potential contributions of our specific profes"m!expertise. Toward this end, I will focus on the
Anahcirntrauma
’ Cdif- Ma
I975- and its effects,
of psychic
(2).> its nature
f complement the findings of the interdisciplinary
of sociologists, psychologists, attorneys, and oth- '
the part
128 thin
annua]
meeting of the
Psychiatric
*^° took
the evaluation
ofAmerican
the effects
of this
^cncc on those who survived it.
T*articles in this section range from the individual
“‘^collective, from the child to the adult, and from
' relationship
his physical
studies
kpest
inner toeffects
to theworld.
widestThese
outer
conof this sudden, unassimilable disruption of
I
address not only the inundation of psychic structures
in a horizontal sense but also the longitudinal effects of
the flood—the disturbed continuity with the past, the
shattering of the present, and the inescapable portents
for the future.
The work of the interdisciplinary evaluation team re
tained by the law firm representing the 625 survivor
plaintiffs to assess the psychological impact of this ca
tastrophe has profound.implications, reflected in its ef
fects on the social .decision-making process’. The un
precedented legal decision, reported elsewhere in this
section by Mr. Gerald Stern, permitted people who
were not on the scene of an accident to be awarded rep
arations for the psychic damages they suffered. The
principle acknowledged in this case could well shake
all'existing rules of the social order about the respon
sibility of man to man.
THE FIRST PHASE: PSYCHIC NUMBNESS
To turn to the central focus about which psychia
trists can reflect and from which other observations
will stem, the Buffalo Creek flood was a violent intru
sion into the peaceful psychic life of the community
massively beyond the “average expectable environ
ment” (3). This eventuality was not, however, com
pletely unexpected—the people in the valley had long
lived with this possibility and knew it could be pre
vented, but they said they had put it out of their minds.
Actually, it had been put not out but deeply in, had be
come part of their living’unconscious. It was in some
ways like the earthquake situation in California but
worse and more constants The dam that finally broke
physically existed just above the valley and was visible
and ever present. Another difference, which added the
makings of a latent’inner eruption to the potential ex
ternal occurrences, was-that there were in rhe minds of
valley residents people (the owners of the dam) who
could and should have done something about the situ
ation. Like-the cave-in of a coal mine in a community
that has alwa’ys lived in dread of such an occurrence,
the flood had been part of the menial as well as the
physical geography of,Buffalo Creek, a feared event
buried in the minds of the people. The massive ,convulsion of the physical world that took place on Febru
ary 26, 1972, was a mental imprint come true. It was a
nightmare from which’.this time they did not awake.
The black .waters that roared through Buffalo Creek
Am J Psychiatry 133:3. March 197a
313
Cv/l RM. OF rs><
WA
>aJJey w hen the fanlasied, feared, and repressed event
became reality could be «a:J to have flooded the egos
of those who lived through the disaster. Al! control
ftincbons were overrun by the sudden influx; it was a
maximum dosage per-unit time, a psychological overki1!. 7he result was universal and with a common base
to all. the traumatic state, the condition of psychic
helplessness that the anxiety signal presages and that
all of the ego's defenses constantly work to prevent (4,
) 7 his u as the phase of psychic numbness observed in
all of the studies of rhe survivors. The goal was merely
to Jis c through it. to survive. Each individual held on
to whoever or whatever was left. “Psychological
conservatism.“ which Drs. Titchener and Kapp de
scribe in “Family and Character Change at Buffalo
Creek," served to reduce excitation; no further stimuli
were wanted.
7 his stage of psychic numbness, of apathy, with
drawal, and sluggishness, was still visible when the
evaluation teams arrived in Buffalo Creek 2 years lat
er. Some of the observers were surprised that the trau
matic neufosis was still visible, but what evidence is
there to assume that the residual or even basic effects
of so massive a trauma' would not last a lifetime? Psycho’ogical testing of survivors of the Nazi holocaust
has shown that after 30 years they still show sucl. last
ing effects as impairment in perceptual-cognitive func
tioning. withdrawal from objects, inability to sustain
close relationships, and other subtle and overt se
quelae.
While the legal experts perhaps needed to be con
cerned about the claim of preexisting states, I would
prefer to maintain clarity and not to have to use the
woid “impairment,” to blur the fact that there was
loss, injury, and illness. The effects of the disaster
were as ravaging as an epidemic of typhus or plague,
w hich is similarly visited upon a city from without, and
the preexisting vulnerabilities in the hosts to receive.
the invading organisms are not an issue. The traumatic
neuroses overshadowed psychoneuroses. I do not
mean to say that there were no preexisting psychcneurjses, but rather that they no longer had a chance
to assort themselves. This is an issue that has plagued
every psychiatrist who has sdrved in the military. Com
bat neuroses in their aCute phases are more uniform
than ditlereni in their presenting syndromes; only later
Can individual diflercnces reappear and assert them-
sehes again. During the years to come, as normalcy
returns to the Builalo Creek survivors, they will have
the luxury of becoming individually neurotic again.
THE SECOND PHASE: “GROUND” AND
“SURROUND”
Vvhat happened to this community in terms of inCorning traumatic stimuli did not slop with the cataclys
mic events of that Saturday morning. As disorienting
*nd tune- slopping us the Ikkxl was, il was only lhe first
phase. An individual who sutlers a loss, however shal-
3M
J Pi.ychiain, 1333, March Mb
'••• •).> J
tering, generally returns to his home to start l. 1
and difficult precess of repair. His “ground,”
ground into which the self can merge, is
his security, the source of the nurturing w*#?, j
sustain the processes of reparation. This wa3 k
sible in Buffalo Creek. The dazed survivors %
turned not to their familiar ground but to neT
strange surroundings. This may have been ib
possible course, but it was still depriving and
threatening. Rather than nurturance, the suniVj
continued to face challenges-, for a long itmcj^ZS
ing a raw and vulnerable state.
?jj
In this double and almost death-dealing bkx^jLj
survivors repeated the experiences of other hokx>.|
known to our generation. Those who surx.vcda^ j
caped from Nazi Germany wandered into
The survivors of the atom bomb relumed tocciel
where their homes had been. Many South AsiamUl
had to leave their land after having left their dead *
all of these cases, the survivors’ earth is alsogoo«||
ter their fellow humans have disappeared.
I
Years ago, writing al another level and about*]
comfortable aspects of human troubles. I dcxiitfl
“attachment to ground” as the psychic prcrtqw^
for the maintenance of the social state of poise to. '
The opposite condition, a wavering hold ononc’j®
rounding psychic ground, results in a basic iiur
with the threat of crumbling and even annihilatin'
the self. This is the source of lhe primitive anxiety lb
people feel at the first threatening tremor of anewvg
quake. In the more mundane case of sea..icknaUj
fear has been said to be not that one will die, MM
one might not. Underlying both of these dixtuiORU
states is an elemental anxiety that stems from4*.
orientation in lhe relationship of lhe organism to4,
earth under its feet.
J
In lhe course of ontogenetic development, if• J
tionship extends from the ground beneath one b 5|
space around him, to people, institutions, ainunp^J
and the culture. This is the common background*
phenomena described by Freud in lhe ord sup'I1' j
the attachment studies of Bowlby (9), in Mahkr
tribulions on separation-individuaiion (10),
I
of motherlessiiess on lhe primates studied b f
low (11), and in the natural e.xperimenls on hun^rf
fanls studied anil documented by Spitz in ca^^ JJ
rasmus resulting from early and massive * s
lion (12).
J
Not only did lhe giound of lhe B iflaloGe*
literally sink beneath the feel of its inhabit^0 *
ing the most primeval regression man can or
but when the survivors reached solid hi^ -4‘
they were again deposited on an insecure
;|
a social “envelope,”—an intuguing ten*1 U'€U. f
Kai 1 j ikson—of unfamiliar space. l he uau*’u
j
not end. it merely changed. There are
mala (13). shock traumata (14), cumol£
mala (15). and sudden overwhelmingdivrunt*'
l he stimulus barrier can be lent as weh^rc^c/f
this point, the trauma of lhe survivors
|
<>■
t
I 1 (> KASC4.IJ,
t0 cumulative. The flood receded, b it the level
did not; rather, it kept rising, although al a
f ffnace.
the phase studied intensively by Dr. Kai
.n,described in this section from the sociological
‘ jJni a ,oss of communality. the social tissue
people together. While this loss was univershould not overlook the fact that it was an inditrauma as well. Just as the original traumatic
although universally shared, was individual in
/fring.s0 was 11 w’,h l^’s second phase of the traucycle- The change from the familiar to a strange
rJ
during the period when rest and nurture were
ijed superseded the initial trauma and prolonged
Jjcomrounded its effects in each survivor.
P4ETHIRD phase: future effects of the
fltAllMA
phe articles presented in this section survey the ef
fects of the disaster to date. Less measurable are the
future effects, especially those whic.i are more subtle
d internal. Are the children Dr. Newman inter
red who are now getting along well in school less
nJnerable to future stresses than those who are cur
rently more turbulent and disturbed? Or is the reverse
die case? Only long-term longitudinal studies (which
rtnot likely to be practical or feasible) would answer
*is and similar questions.
Fhere are subtle and. far-reaching issues facing the
wrvivors. In spite of the vastness of the unconscious,
psychic space is limited. There is room and time in any
individual psyche for only a limited amount of cogni
tive ideation and a finite number of memories, fan
cies, and accompanying affects. The product of such
space and time comprises the psychic life of an in di vidail, the amount already spent and the amount still left.
Mourning is a model of such an occupation of psychic
?ace, a paradigm of how obsessive thoughts and.memones related to psychic work that needs to be done
crowd and consume the psychic capacity. Traumatic
memories of any kind encroach on this psychic timeWcand reduce its available quantity; this is why psydiic traumata age people.
I have been treating a woman in her mid-seventies
^have discovered that her apparent senility is due
to an organic aging process but to the repression of
of a traumatic life. She had told herself—she
^J&ht this out with clarity through her foggy memosessions that had a hypnotic quality—that she did
^*ant to remember any pail of her married life of
50 years. The volume and intensity of (he trau-
. . memories being repressed left her almost no'
for normal living. She had by now assumed the
?j''rc’buth mentally and physically, of a diffuse corWrophy; without evidence, either neurological or
°&ical, of any organic syndrome nor even conof cerebrovascular disease.' She was like a
acute, traumatic amnesia, except that this was
chronic, old. and massive. Her mental state undulated
dramatically with the emergence and rcrcpresMon of
forbidden thoughts. This poignant clinical experience ,
has made me wonder about the general psycho
pathology of “old age.”
How much space will the Buffalo Creek experience
occupy in the minds of the survivors in their future
lives? We routinely treat patients who react to i de
prived childhood by sacrificing a certain percentage of
their psychic lives. I have treated a patient who has oc
cupied perhaps a quarter or a third of her free associa
tions with obsessive preoccupation over her screaming
mother; her thoughts arc similarly occupied outside of
the analysis. Another of my patients has been unable
to enjoy his current life because of the constant crowd
ing of his psychic space by the coalesced memories of
the threats of castration that pervaded his tortured
childhood. I have pointed out elsewhere (17) the role
of such chronic traumata in producing the cacophony
of human relationships in ordinary life. •
These situations represent fairly common devel
opmental traumata. How much more of a role do cata
clysmic traumata like the Buffalo Creek disaster play?
What will be the long-term effects of the vivid, massive
“death imprint” described by Lifton and Olson (1)?
What will be the effects on children in whom death anx
iety has been violently added to the normal anxieties
of separation and castration? It seems likely to me that
their memories will repeat the accumulated traumata
over time like a long-acting timed-release capsule.
There was an element in this disaster that is not
p.esent in truly natural catastrophic events, which
serves to explain further why the “Buffalo Creek syn
drome” is not limited to reactions to external events,
but rather reflects added internal idiosyncratic forces.
I am referring to the human element, the thought and
the accusation that this horrible occurrence could have
been prevented. Unlike a natural disaster such as a tor
nado, where inanimate forces of nature are soiely re
sponsible, the human object was involved in the Buffalo
Creek Flood, which- arouses impulses of aggression
and retaliation. Channels for discharging these im
pulses do not keep pace with the amount and quality of
the impulses aroused. .The ego is bombarded from two’
directions, and feelings of rage, impotence, anxiety,
guilt, and depression are added to the usual responses
to disaster.
The more external normalcy returns, the more will
traumatic neuroses and psychoneuroses be in a recip
rocal relationship to each other. The residual trauma
will stimulate individual neuroses, and latent neuroses
will feed upon and perpetuate the traumatic state.
Such restifutional movements are already evident in
the survivors and will increase with passing time.
Phobias, obsessions and depressions, and private anx
ieties and conflicts have already been noted by Various
observers, and survivors' dreams are beginning to re
veal their predisaster concerns.
There arc other niore subtle unknowns to cloud the
future. What happens when a traumatic effect merges
Am J Psychiatry
AZsmv/t Mb
315
COUFSF.OF PSYCHIC
TRaCMA
/ ’
.*
over timr into a traumatophilia? Such an outcome can
repicscnt a repetition compulsion not in the service of
ruMvry Nh to satisfy a sense of gu:lt or a need for pun
ishment.-a trauma that is absorbed and utilized by the
psvchic forces “beyond ihc pleasure principle” (18V
Or v. hat will he the result when the pleasure formulae
. or safety mechanisms themselves become altered and
f individually fashioned ay a result of the traumatic expe• hen c? I am reminded of* a patient who was traumati
cal J y raped and now finds her husband and all other
men to whom she turns passive and.weak. Or a patient
who. from a traumatic rejection in her first love, has
come to no longer believe in love. Another patient,
similarly hurt, now feels ”1’11 never again have a best
frrnd.” What will be the effects of the life-threatening
insult at Buffalo Creek,'seen .by the survivors as a re
mit of neglect by pcople.in authority, on trust, love,
and object relations? One can hardly begin to tell, but
one can b: prepared so as not to be surprised.
In surveying this event and the reports that have
been presented in this section, we should not overlook
the effects of the studies themselves on the 625 survi
vor-plaintiffs evaluated. Aside from the legal result,
the interest displayed by caring individuals from the so
ciety outside the valley probably introduced a thera
peutic influence, however, circumscribed. This influ
ence might be compared to the effects on a therapeutic
ward of the mere announcement of a program of treat
ment. However, there may also be negative effects:
divisiveness has been introduced in the valley. Just as
the untreated “control ward” suffers by comparison
with the therapeutic community, those survivors who
were not among the litigants may feel left out and dis-’
crimi .ated against.
While an important and unprecedented legal deci
sion has been achieved that greatly extends the defini
tion of psychic trauma follow ing an external event, the
full implications of the human phenomenon described
in this section cannot Ik* estimated. Anyone who is
lost, hurl, 01 otherwise affected under traumatic cir
cumstances aflects others in an endless chain that is at
tenuated only by emotional distance. Il would be illu
sory to tvehese that it is within our power or profes
sion^ expertise to accurately describe ethical
guidelines tor the rectification of the linear progress of
traumatic effects. 1 recently knew of an elderly couple
who were being displaced fiom their home for the
budding of a federal project. During the process, the
husband, distraught over the dislocation, suffered a fa-
tai heart attack. What can we say or what
d
■'
w I
do about the effects on his wife? Or the children?0/ F
chain of others? There are more questions
answer. We must work side by side with the law. J?
sociology, philosophy, and all thinki ig and f^
people. No one or no group has.a comer on etNc,*
on wisdom.
REFERENCES
|
I. Litton RJ, Olson E: The human meaning of total
J
chiatry (in press}
’/y y
2. Range’ll L: The metapsychology of psychic Iruurrn, « hydb I
Trauma. Edited by Furst SS. New York, Basic Books IH’ » |
51-84
I
3. Hartmann H: Ego Psychology. and the Problem o< Au^ ?
tion (1939). New York, International Universities Press, in 1
4. TreudS: Inhibitions, symptoms and anxiety (1926). in TN Cge I
plete Psychological Works, standard ed, vol 20. Translated
|
edited by Strachey J. London, Hogarth Press, 1959. pp 7}.|M J
5. Rangell L: A further attempt to resolve the “problem of
f
iely." J Am Psychoanai Asso 16:371-404, 1968
|
6. Rangell L: The psychology of poise—with a special clabunM j
on the psychic significance of the snout or perioral region.
I
Psychoanai 35:313-333, 1954
I
7. Rangell L: The quest for ground in human motivation. Uap* ?
lished manuscript. Presented at the meeting of the W<M Cuwi ■
Psychoanalytic Societies, San Francisco, Calif, Oct 29. IMJ I
8. Freud S: Three essays on the theory of sexuality (1905), mtU |
Complete Psychological Works, standard cd, vol 7. TruiMNi |
and edited by Strachey J. London, Hogarth Press, 195). pp 15 I
245
j
9. Bowlby J: Attachment and Loss, vol 1: Attachment. New YX I
Basic Books, 1969
I
10. Mahler MS: On Human Symbiosis and the Vicissitudes 1* J
vidualion. New York, International Universities Preu. 19* w
II. Harlow HF: Social deprivation in monkeys. Sci Am,
*
136, 1962
|
12. Spitz RA: Hospitalism: an inquiry into the genesis of psycW*
conditions in early childhood. Psychoanai Study Child MFA <
1945
I
. 13. Sandler J: Trauma, strain, and development, in N* |
Trauma. Edited by Furst SS. New York, Basic Book*, I*’ # t
154-174
I
14. Kris E: The recovery of childhood memories in psycbc*“b« 1
Psychoan"1 Study Child 11:54-88. 1956
I
15. Khan MMR: The concept of cumulative trauma.
g
Study Child 18:286-306. 1963
I
16. Kris M: Discuss.on presented at the Symposium ofl l»*
I
Trauma, Psychoanalytic Research and Developmc^
I
New York, April 3-5, 1964
. |
17. Rangell L: On the cacophony of human relations- PsyiR^- ..
42:325-348, 1973
J
18. Freud S: Beyond the pleasure principle (1920), inTN < * j
Psychological Works, standard ed/vol lb tumbled
I
cd by Strachey J. London, Hogan h Press.
PP 1
<
I
Ac; J
/.uj. March ISf76
cOMM(JNITY
K'urn.ilof PjichosoiHjt-.c Rcbcarch, Vol. IS. pp 437
43b. 1’crj.jmon Press, 1974. Printed in Great Britain
'im
ex S -
]/ Main
^Orarn°nga|a
DISASTER: EFFECTS ON MENTAL AND PH YSJC^°re'66u^4
t
I
I
Warren Kission and Rachel Rosser
(Received 13 May 1974)
Abstract—Although there is an extensive literature on various aspects of disaster, there has been no
comprehensive review of its psychiatric consequences. This article brings together the phenomeno
logical and dynamic descriptions of the immediate and longer term mental effects of disaster as
observed in the individual and in groups. Present knowledge on management of these effects is
summarized and some conclusions arc icachcd on (he implications for future planning of disaster
icl cl sei>ices.
"(\7’/
ii:ui !<>
Mine is i/imi/u ”
Nietzsche
j
'
|
i
Tur genfrai. field of enquiry loosely encompassed by the term “disaster” has not yet
■
;
found an established position in the psychiatric canon. There seem to be theoretical,
practical and emotional reasons for this. A disaster besets the researcher with major
practical difficulties. In his review aitide, I locking |l] identifies the following theoretical difficulties: the subject overlaps with other disciplines (notably sociology), it
challenges ’he existence of a boundary between illness and health, and it is relatively
iemote from traditional psychiatric approaches such as organic psychiatry, experi
: |
. ‘
j
1 1
mental psychology and ; ? choana lysis I lowcver these factors alone do not appear to
;
be an adequate explanation for a delay of 17 yr before any .systematic or detailed
siudy of the psychological and social effects of the atom-bombing of Hiroshima. Until
I ilion’s classic study Published in 1967 [2j all that was available were a few fragmentary, or exaggeratedly technical, reports, and l.ifton noted that often researchers were
j
I
so shuck by the human sulfcnng encountered that they ceased research and dedicated
themselyes to much needed social welfare programmes.
Equally conspicuous is the omission of psychiatry from the disaster canon. The
field has been studied by sociologists, medical workers, administrators and military
strategists. It is covered routinely by the media and provides a stimulus fur the
cicative arts. But the extensive literature on disaster planning does not consider
psychological understanding and the psychiatric needs of the victims.
fhe absence of disaster in the psychiatric canon is of theoretical interest. However
the absence of psychiatry from the disaster canon reflects a lack of insight which is of
practical consequence. This was shown in the Hartford Disaster Exercise [3]. In this
project, a simulated major explosion was arranged in cooperation with the Health,
Police, Fire and Civil Defence Departments, five hospitals, the Red Cross and
Ambulance Association, the University Department of Medicine, the State Depart
ment of Health, and the local medical association. The episode was videotaped and
the “victims” subsequently interviewed. It was found that the rescue personnel
became confused and were disturbed by the sight of massive injuries, and that the
victims were unnecessarily handled and placed in uncomfortable, inconvenient and
dangerous^positions. At no time did anyone stay with a specific victim to give comfort
<•
* The Maiitlslcy Hospital, London, S.E.5, England.
t
1
1
1
f
(
.
I
s
N
Warrfn Kinston and Rachfi. Rosser
438
and reas.craiKe. In the 10 yi pri *r to this there had been only four other well docu
mented and comparable studies and the findings in these were identical The explana
tions offered in the article ..ad subsequent Arm Lowland Journal of Mcdii inc editorial
[4] were in terms of “poor rescue" and tl. • existence of a “community problem”.
1 here was no mention of psychological understanding
This article is an attempt to use the information in the literature to develop a
psychiatric approach to disaster and to suggest its implications for the planning of
services, The nomcnclatuic of Tyliurst [5] and Glass [6] is tned. A limited number of
outstanding psychiatric papers are described in detail and other documented psycho
logical phenomena arc mentioned. The long term effects are examined in the context
of the phenomena of World War II.
DEFIN'D ION: CLASSIFICATION: I.)IFFICl.'LTILS
Disaster is defined, for the purposes of this review, as a situation of massive,
collective stress. The psychological phenomena of disaster are the consequences of
the combined individual stress reactions and of reactions to changes in the social
milieu, Hence the psychic distress and behavioural disturbance of an individual
cannot be fully understood or managed unless they are analyzed as elements in the
disruption of the equilibrium of a social system. “When an entire population is
reducer] to inferior status” for example “the individual’s self-respect is damaged in
ways not reparable by himself’ (Krystal [7]).
As a consequence, hypothetical models may become unmanageably complex
(Barton 18'). But in addition there are more practical obstacles to coherent research
and understanding. The physical situation of a disaster is rarely one which lends itself
to the usual research techniques, the psychological sequelae powerfully affect the
observers, there is a great variation in the types of disaster, and they exist in completely
different socio-cultural settings. Often the victims resist investigation, and the relief
organisations resist investigators.
There is no generally agreed or obviously fundamental taxonomy. Constructs of classification have.
included: man-made (e.g. bombs), natuial (eg. fire); internal (e.g. tyranny, inflation), external
(e.g. war, flood): acute (e.g earthquake), chronic (e g poverty, racialism). Tyhurst [5, 9] provided a
classification of die phases uf disaster vvhicii was extended by Glass |6j and has been accepted by
man) psychiatric v. nkcis ('l ai I.- I). These and. ts define live phases: pre-impact (threat), warning,
impact, recoil and post-impact. During die impact phase the stress is physical, maximum, direct,
unavoidable; prior to this it develops from the stress of worry and preparation to one of imminent
danger, and subsequently secondary stresses due to the nature of the disaster and its effects on persons
and property begin to operate. The detailed descriptions of each of these phases is still incomplete,
because most studies arc varying mixtures of anecdote, description and analysis. As early as 1957
Demcrath and Wallace [10] pointed out the absence of i defined disastcrology. However despite the
subsequent amassing of data, Barton [8] commented in 1969 that most of it was valueless and that
researchers still had not developed a set of propositions to lest. The diffuseness of the literature has
also resulted in important discrepancies remaining undebated.
, ;
METHODOLOGY
The methods vary in the number of victims studied, the detail in which they
investigated and the extent to which the information is systematic and quantifiable.
|
They include single case reports, numerous anecdotal studies, some more systematfcj^MJ
studies and experimental work. The peculiar methodological problems have beenTrfe^
analyzed by Killian [11].
J
•
1
Hit-
V
Table 1.
Pre-impact
(threat)
Stress
Of education, worry,
preparation etc.
Warning
Imminence of primary stress
Impact
Maximum, direct, unavoidable
Recoil
Suspension of primary stress.
Secondary stresses due to nature
of disaster or self
Post-impact Derivatives of primary and
secondary effects: personal and
social
Further details in text and bibliography.
HASIS OF DISASTER (BASED ON J 1'1 CI OSSIFICATION Of TyHURSF AND Gt-ASS)
Du ration'time perspective
Mon’hs-ycars/futurc
in-hr/present or immediate
-.ire
Min -hr, months-yr;present
• automatic)
Depends on individual and
di'-uster/immediate past
Rest of life/past-prcscnt-fi lure
Psychological phenomena
Denial or over-reaction vs optimal
a mount of-anxiety
Social phenomena
“Optimal social stress
Social preparedness
Denial vs protective action
Precautionary activity
12-25 per cent effective, tense,
excited, too busy to worry
75 per cent dazed, stunned.
bewildered i.c. disaster syndrome
(absence of emotion, inhibition of
activity, docility, indecision, lack of
responsiveness, automatic
behaviour 4 physiological
manifestations of fear)
12-25 per cent grossly inappropriate
behaviour, anxiety and affective
states, hysterical reactions.
psychosis
Scope of impact: community to
nation
Emergency social s. Mem: the
unorganized immediate rcsponv
(role definition, role competence)
with ad hoc leadership.
Family as the basic unit
P.
VZ!
□
Normals (90 per cent) show return of Convergence behaviour
Inventory and rescue
awareness and recall. Dependency,
Organized reconstructive effort,
talkativeness, child-like behaviour,
emotional release. Search for safety. jciicf and restoration of services
Unstable gioup formation.
Psychopathic liberation. Special
phenomena c.g. staring reaction,
counter-disaster syndrome
Grief, depression, post-traumatic
neuroses
Psychosomatic illness
Increased physical illncss.deaths
Altered attitudes
Recovery (?)
IS*
Permanent reconstruction and
long-term recovery. New
equilibrium with modifications:
alterations in morale, economy,
cultural values. Feed-back to
threat phase
S
r.
440
Warren Kinston and Rachel Rossi r
(1) Single cases
Except for the psychoanaly lical literature, there are surprisingly few case studies. One of the earliest
scientific reports was that of the surgeon, Jean Baptiste Henry Savigny following the ship-wreck of
the iMeduse, well known from Gcricault’s painting [12]. Similarly James [13] recorded his reflections
on his mental reactions following the San Francisco earthquake of 1906. In his account of his own
ship-wreck experience, Lilly [14] reviews other similar personal experiences which led to hallucina
tions, confusion, xiranoia, suicide, murder and cannibalism. Jams [15] used a transcription of the
delirious ramblings following rescue to analyse the fantasies and the elements of the unusual mental
resilience of a young man who narrowly escaped drowning. Although this experience would not
strictly fall within our definition of disaster, information from such a study is important because
studies of individuals during the acute phase of massive collective stress arc not available.
(2) Anecdotal accmint..
Anecdotal accounts vary in sophistication. Often they arc produced by "experts” who happened to
be on the scene at the time [16-25], but sometimes planned studies arc reported in anecdotal form
[26-31].. The primary result has been an extensive duplication of certain fundamental observations
which will ( e described in the section on Psychological Phenomena. The data is not sufficiently
uniform to permit comparisons to be made, but a number of the papers contain interesting and
potentially significant details which do hot appear in the more systematic studies.
(3) Systematic studies
Methods used for systematically collecting information include clinical studies, structured inter
views, questionnaires and hard observations of a limited number of parameters.
Clinical studies contribute most of the information on the opportunities for and the effectiveness of
psychiatric intervention [32-40],
Lifton’s study of the victims of I liroshima [2] is one of the best examples of structured i terviewing.
I Ic picked 33 survivors at random from lists kept by the 1 liroshima University Research Institute for
Nuclear Medicine and Biology plus ’2 survivois who wcic particularly articulate or personally
prominent in the /Vbomb problem. Inc interviews were iccordcd, tianscribcd. and translated, and
they specifically explored the individual’s recollection of the original < \perience and its meaning in
the present, residual concerns and fears of all kinds, and the meaning of his identity as a survivor.
Qualitative case studies using interviewing techniques have been extensively used by sociologists.
However, Barton [8] reviewing 21,600 interviews of 103 disasters dealt with by organizations such as
the National Academy of Science Disaster Research Council, University disaster investigating
committees and the National Opinion Research Centre, found that after excluding false alerts, morale
surveys, epidemics, small samples etc. he was left with 5,500 interviews of 22 disasters of which 4, ill
were quite unsystematic, leaving 1,500 interviews of the Holland Flood and the Arkansas Tornado.
1 he latter study by Fritz and Marks [41] is very frequently quoted. It demonstrates the importance of
the question of retrospective falsification since it reports a nuch lower incidence of transient shock
than is usually described and the validity of the figure is not investigated. Other studies u<r.interview
lechi.jqucs provide useful data [42 -45].
Que-lionnauev m contrast with more or lc-«s unstruciuicd micsv ws, have the ad\...Hage il.at
systematic quantifiable information is obtained from a large population. Their disadvantages are
that they depend on recall of a traumatic experience weeks after the event. Also they often cover
areas in which the questioners arc not expert, and this has produced one soiree of controversy
(Quarantelii and Dynes [46]). This technique has been applied to a limited extent by psychologists
and sociologists.
Observations using epidemiological methods give a limited amount of reliable information. A few
such studies are available such as Bennet’s study of the effects of flooding in Bristol on subsequent
mortality rates in the affected population [47).
(4) Experimental studies
There arc three principal experimental methods. Disasters can be simulated, as described by
Mcnczcr [3]; however, this method has not been used to study psychological phenomena. The
reactions of people in particular stressful situations can be recorded e.g. the observations by Pope
and Rogers of the mental state of a group of scientists during an arctic survival experiment, or
Ahearn’s [49] study of the reactions of large groups experimentally confined in an austere environment
In addition conclusions relevant to disaster may be drawn from many of the results of laboratory
experiments on psychological reactions to special stresses such as sensory deprivation or starvation.
Disaster: Effects on mental and physical stale
441
(5) Journalistic ai counts
Editors find that disasters arc an inexhaustible source of excitement for their readers. Newspaper
th. counts often provide particularly detailed information on emotions and attitudes of the victims and
rescuers which is unobtainable elsewhete. One of the best recent accounts of cannibalism is probably
the Sunday Times report on the Chilean air crash of October 12th, 1972 [50].
CASE STUDIES
We have selected tl rec papers which together define many of the immediate,
short term, and longer term psychiatric complications to be expected in a disaster.
The first of these is the major contribution by Cobb and Lindemann (1944) studying the survivors
of the fire at the Cucoanul Grove Nightclub [35]. This study was done at the Massachusetts General
I lospital where 114 of the casualties were taken. 39 weie alive on arrival. The city fire services and the
.hospital emergency programme were geaicd up in expectation of air-raids and handled the disaster
with exemplary efficiency. The dead were identified immediately and the survivors listed, thus avoiding
feelings of confusion, hostility and despair which have been documented when this is not done. The
relative* were interviewed by social workers who involved the psychiatrists in the care of those
overwhelmed by acute grief. 1 rom the relatives the psychiatrists tuned to the injured, all of whom
they visited on the Sih day. fourteen of the 32 survivors had ..europsychiatric problems; the
commonest problems (50 per cent) were reactions to bereavement, but there were also cases of
psychosis, phobic anxiety and complications of carbon monoxide poisoning. It was this work which
enabled Lindemann to provide the first detailed description of the phenomenology of acute grief [34].
Cobb and Lindemann drew the following conclusions: (I) Psychiatric problems will be overlooked
unless a psychiatrist sees all the victims of a disaster. (2) Severe emotional problems are due to .
crises in humap relationships involving conflict and guilt rather than to the impersonal horror of the
disaster itself, hence the nature of the disaster may not be a useful predictor of consequent psychiatric
morbidity'. (3) A psychiatrist can be useful in three phases, (i) initially during emergency medical care,
when confused.excited patients have to be removed to quiet surroundings and sedated: in this phase
patients arc disturbed by the frequent changes of medical and arsing staff and me psychiatrist can
piovide continuity by dewloping a relationship with them; (ii) then during cotp.ak'sc-’tke in hospital:
psychiatrist' can adv ise or. the liming of bad pews and can support the patient in adjusting to bei cave
rn...it. material loss and disability; (in) finally when the patient returns to the community: psychiatrists
can help to reduce prolonged maladjustment and traumatic neurosis. It is striking that despite
excellent planning and numerous precautions designed to minimize psychological stress, there was a
high incidence of psychiatric illness. Numerous subsequent studies have confirmed that much serious
psychiatric morbidity goes undetected by non-psychialiicaily trained medical personnel [51, 52],
The second study by Leopold and Dillon [32] described psychiatric disturbances in
36 survivors of a marine explosion in 1957 on the Delaware River.
Initially almost all had features of a post-traumatic neurosis. In the ensuing 4 yr the symptoms be
came worse, most of the victims requiring psychiatric treatment. Of particular importance to these
conclusions was the elimination of compensation a> an actiological factor in prolonged morbidity.
. I he third study by Popovic and Petro.ic [36] described (he Skopije earth quake and
consisted of observations made b\ psychiatrists within 24 hr of a major disaster.
Of the population of 209,000, 3,300 were injuicd and ovci LUX) k;ILJ. I he ln*ti:ute cf Mental
Health in Belgrade sent two psychiatrists, a psychiatric social worker and two nurses; they arrived
22 hr after the earthquake and stayed for 5 days. A team of local psychiatrists was organized to tour
evacuation camps and a reception centre was established for acutely disturbed patients. They noted
that much of the population was in a mild stupor which the team found infectious, that the victims
congregated in small unstable groups and that rumours of doom spread. After the initial confusion,
severe psychiatric disturbance was rare, and this they attributed to the rapid evacuation of the more
disturbed patients, to prompt outside help, and to responsible reporting by the press which minimized
the formation of rumours. Depression was prevalent on the 2nd and 3rd days while after-shocks
continued. Children who were evacuated to institutions were transiently disturbed.
Although these studies are detailed and relatively comprehensive, and many
subsequent papers have confirmed their principal conclusions, they do not explore
some areas of practical and theoretical importance. They do not stratify the population
at risk: in practice it would be valuable to be able to predict the more vulnerable
sections of the community, their dillerent patterns of response and the appropriate
management of these. They document the commoner psychiatric phenomena but
442
Warriin Kinston and Rachel Rosser
omit the less frequent reactions e.g. pscudopsyclioses [53] and hysterical reactions [54],
They arc written in behavioural and phenomenological terms but it has been necessary
to search elsewhere for dynamic understanding of human expc iencc during the
various phases of disaster.
PS YCHO LOG ICAL PH F.NO M I 'NA
The literature on the psychological phenomena of the threat, impact, and early
aftermath phases was comprehensively reviewed by Wolfenstein [55]. The principal
findings in this monograph are summarized here. There is no comparable review of
long-term clfects. However the effects of some of the exceptional stresses • f the
Second World War have recently been studied and the war neuroses, concentration
camp sequelae, and the Hiroshima A-bomb effects are used in this paper as paradigms
for the understanding of long-term consequences of disaster.
Threat
In the threat phase, denial of the potential disaster may be superficial or deep, it may be continuous
or intermittent, it may be total, partial or minimal, but it seems to be universal and in that sense is
"norma! ' (Wolfenstein). Persons who get fearful and go to psychiatrists tend to be diagnosed as
“neurotic". Lifton [2] would refer to this denial as a "consistent human adaptation’’. Like any other
adaptation it has its advantages and its disadvantages. All responsibility ..ends to be displaced onto
leadens or authorities. The individual feels that he has neither the knowledge nor the means to affect
his own destiny. The authorities attempt to use a rational approach as part of the constructive worry
ing they are paid to do. However, predictions arc often so inaccurate ’hat they seem to be based
more on fantasy than reality, l or example in Woild W ar 11, expert advisers to the British Government
predicted 20,(X>0 50.000 deaths per day from air-rai ls, whilst in 2 yr the total number was about
45,(XX); they predicted mass panic which was totally absent; and by contrast they estimated destruc
tion of property at one thirty-fifth of what it was (Schmideberg [56]). Denial continues through the
warning phase and sometimes into impact. Acknowledgement of the danger would result in physical
inconvenience and psychic distress. During the Hawaiian ts»tn..:ni (tidal wave) of May 1960, for
example, evacuation was minimal [43]. People may openly refuse to fantasy the danger, e.g. on the
banks of the Rio Grande festive crowds.watched and cheered the rising flood waters [551.
When the danger is admitted emotional attitudes such as faith and distrust become important,
because of the difficulties of knowing the efficacy and reality of the precautionary measures taken by
the relevant authorities. The authorities are seen as "parents”, and the disaster is attributed to the
“powcrs-that-bc”. Rules of safety thus become equated with rules of obedience e.g. in the blitz
people left uncovered windows which the wardens could not see. Superstition and ideas of magical
control flourish, e.g. the fear that disaster may be precipitated by thoughts, speech or actions. Fantastic
'umours which indicate a change in the way in which life is construed arc common: the classic one
.. that a drug I u.s been nut in ihc wine or water to reduce libido and potency [551.
Impact
In sudden sewdisasters, there is an illusion of centrality. For example in a tornado people believe
ihatonly their own house has been hit. The myth of personal invulnerability, so powerful in the threat
phase, suffers a sudden reversal: the individual is actually encountering death. There then follows a
second major shock when the total destruction is appreciated and the expected sources of refuge and
aid arc absent. Recollections of this period vary greatly but the evidence suggests that individuals
swing between feelings of terror and elation, invulnerability and helplessness, catastrophic abandon
ment and miraculous escape. The subsequent reconstruction of the illusion of immunity depends Oft
whether the disaster is experienced as a ‘‘near miss” or ‘‘remote miss”, and on the actual
loss.
•
. •.
Soon after impact victims appear to be “dazed”, “stunned” or “bewildered”. They show absence
of emotion, inhibition of activity, docility, indecisiveness, lack of responsiveness and HHtenWiCh-fflR
behaviour, together with the physiological manifestations of autonomic arousal. This is the “disaster"?'*’
syndrome” (Wallace [42]). It has been explained in various ways: as apsychic closing off from furthat
stimuli, as energy being drained to intense internal work, as a response to fantasies like "if I
react then nothing has happened” or to feelings of helplessness and the impossibility of undoing tlT
the damage. This reaction is the antithesis of the commonly anticipated one of panic. Panic b
Disaster: Effects on mental and physical state
443
conceived as a reaction to the conflict between egotistic and altrui:>..c impulses. In the face of massive
death, people have unacceptable feelings such as sadomasochistic excitement, and ideas and wishes
such as “rather him than me” (as if there were a competition for survival) and “he can die instead of
me” (as if the death of one person assured the life of another). The thought of sacrificing others to
survive oneself is common in fantasy (though the action is rare in reality) and produces guilt feelings.
Panic only occurs under very specific circumstances which are not the rule in disaster, and a large
body of research indicates that human beings under threat of death are not motivated by a simple
drive for physical safety [57]. A complicated social situation with a wide variety of attitudes and
motivations develops [58].
Recoil
In the recoil phase, the normal response is a slow return of awareness and recall. The victims become
dependent, talkative, childlike, form unstable groups and seek, safety. Emotional release occurs.
Specific patterns of behaviour have been noted. There may be psychopathic liberation including
looting, rape and heavy drinking [18]. Wallace [42] has described a “counter-disaster syndrome” of f /
over-conscientiousness, hyperactivity, loss of elliciency and irrational behaviour, e.g. a surgeon
abandons sterile technique. The "staring reaction” also occurs in outside observers as well as those
involved, and along with "convergence behaviour” may interfere with rescue and relief. It is accomp
anied by obsessional preoccupations with the personal implication of the event. Following the murder
of J. F. Kennedy, the average U.S. adult spent 8 hr per day for the next 4 days at his T.V. or radio,
and Janis [15] interprets this as an attempt to work through the cultural damage.
I
I
Early aftermath,I
As the unorganized immediate individual response gives way to the organized social response, it
becomes clear that psychological events have to be understood in the context of a social situation
within a particular culture at a given historical moment.
Psychological reactions to loss of loved objects and grief reactions always feature significantly and
their tharaciciistics haw been well described in the literature (Parkes [59]). T he expression of these
emotional states may be alfccted by culluial attitudes. Wolfenstein comments, for example, that in
the U.S. there is a prohibition against experiencing despair, helplessness and discouragement wh.ch
conflicts with the victim's need for acknowledgement of his suffering. Feelings of fear and apprehen
sion commonly pei^isl for some time. U lally they arc linked to the idea that the disaster will recur;
aftershocks of earthquakes arc associated with much more conscious fear than the initial major
shock. Also new disasters are fanlasicd and as rumours these fantasies rapidly spread. For a while
the world is an unsafe place and people feel anxious about being left alo.te or separated from their
loved ones.
There arc extreme emotional difficulties in dealing with death, especially on a
massive scale, and altitudes towards the corpses are coloured by fear and guilt. On
the one hand authorities deny them importance (“nothing needs to be done” U.N.
Disaster Relief Coordinating Committee) and insist on rapid disposal by incineration
and mas> burial [60], On the other hand, survivors have difficulty in mourning their
relatives unless they “know” of the death by identification of the body: alter the
earthquake in Naples in 1968 people spent days searching the rubble for corpses [60].
Following any disaster, relief operations are impeded by enquiries about missing
people.
The disaster persists as a “tormenting memory”. People are apt to find themselves
forced to relive it over and over again and, although this is painful, it seems often to
be curative in that the feelings of extreme distress associated with the event are
gradually extinguished. Repeated discussion often focusses on regrets and recrimina
tions regarding actions taken before or during the event. For a few the distress and
fear do not diminish and they “do not get over it”; others avoid any reminder of the
experience and may deny actual consequences. The memory is subject to intra
psychic distortion. William James wrote on the 1906 San Francisco earthquake:
“I realize now how inevitable were men’s earlier mythological versions (of disaster)
and how artificial and against the grain of our spontaneous perceiving are the later
j
444
Warren Kinston and Rachel Rosser
habits which science educates us” [13]. He refers to the re-evocation of primitive
animistic views of causality in which the disaster is seen as intentional and purposive.
People are unable not to ask the reason why, and they invoke God, destiny, fate, or
similar substitutes which are endowed with human qualities and a relationship with
humanity. Associated with this intense intrapsychic relationship with the powersthat-bc arc thoughts and feelings about leading a better life or relaxing moral standards,
altitudes of defiance, ideas of being punished, and postures of hope or despair.
Survival may be seen as a confirmation of immortality, as being protected again, or as
evidence of continued victimization.
A disaster also incorporates many situational therapeutic factors [28] and Wolfenstcin describes the well-documented phenomenon of the "’rise and fall of the post
disaster utopia ’. To the survivors it is a relief that the threats and dangers have come
from the outside and that he can feel blameless; the remedial needs are specific,
immediate, obvious and preponderantly physical, and results arc quickly seen from
attempts to deal with them; danger, loss and suffering are public not private and are
immediately present so that there is a liberation from the past and future; and the
most damaged families are a support for the remainder (“relative deprivation”).
The initial tendency following a disaster is to give without stint and accept without
testraint, but this soon becomes replaced by feelings of hostility, giecd, independence,
suspicion, envy and competition. Tor example the relief organizations, which give
compensation on needs not losses arc resented because the individual's experience is
proportional to his loss. The problem of anger, blame and hostility is extremely
complex as these affects arc always evoked and variously displaced, often with
damaging consequences. Lacey [27] comments on the hostility of Aberfan directed
towards the National Coal Board, Local Authority and Government which hampered
recovery efforts, and towards the Tavistock research woikers. Wolfenstein gixes many
examples of the inappropriate handling of these feelings. Reports repeatedly highlight
the irrationality with which such irrational matters are handled.
Following massive destruction of a place, people prefer to move back and rebuild.
Relatively few move away and those who do so tend to for “neurotic” reasons. This
has 1 ;en seen many times in tornado cities, bombed cities, Hiroshima, and now in
Managua which is being rebuilt on the identical site for the third time after total
destruction b\ earthquake. Material reasons do not seem enough to explain this, nor
sentimental attachment. The myths which justify remaining on the rite include the
inevitability of fate, the belief in the random distribution of disasters, and the idea
that running away will provoke further disaster. There aie also feelings of loyalty and
guilt, wishes to undo the damage or to master the event, and defiant refusal to be
scared away.
:
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Special groups: children
The first major group of papers emerged from the experiences of the bombardment
and the evacuations and parent-child separations during World War II [61—63].
Acute disturbance was found to be common, but transient, if separations did not
occur; separations however had lasting effects sometimes. More recently the effects
of disaster on children have been described in detail and some predisposing factors S
have been defined, c.g. Fraser [64]. Children’s reactions must be understood within
li
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Disaster: Effects on mental and physical state
445
the context of the family. In the early phases of disaster their reactions are a function
of the way in which reality filters down to them and so they mirror their parents’
reactions rather than relating directly to the event [65-67]. The most predominant
fear at all ages is separation from the parents. If this docs not occur, and if the parents
cope with the situation, children may show little awareness of danger and minimal
anxiety. The “disaster syndrome’’ in children takes the form of purposeless excitement.
Studies or the Vicksburg tornado [37, 45, 68] in which many children died in a matinee
cinema performance confirmed the high incidence of manifest regressive and
behavioural symptoms and suggested that the slowest rate of emotional recovery
occurred when parents created a tense atmosphere in which the episode had to be
“forgotten*’. Most families could only permit one member to grieve at a time. Parents
who were pathologically distant from or demanding of their children became more so
at impact and recoil (also 64). In the early aftermath children show compulsive
patterns of working over the disaster and associated painful scenes, such as burials,
verbally, or in play and drcams, often to the distress of their parents. Post-traumatic
fears of recurrence and reactions to reminders of the event are indicative of pathology
related to mishandling of the earlier phases. 1 he general conclusion is that children
rarely\nccd specialist psychiatric treatment but that they do benefit from an oppor
tunity to ventilate their anxieties to a sympathetic adult. Those most at risk arc
between 8 and 12 yr, have a previous history of physical or emotional illness, and
come from unstable homes.
S pecial groups: the aged
There are few detailed studies of the behaviour or of the subjective experience of
the aged in disaster. The literature has recently been comprehensively reviewed by
Friedsam [69], and general aspects are discussed by Townsend [70] and Titmuss [71].
The aged usually receive warnings later than the rest of the population, are less
willing to leave their homes, restrict their attention more to immediate family and
less to other members of the community and are particularly at risk of physical but
not of psychiatric damage, although a brief reaction of agitated depression with
confusion is common. ]n general the old experience a much deeper sense of deprivation
than the younger members uf the cummunilv, this reflecting the real impn ^ability of
their being restored to their former stale. 'The aged of low socim status experience
strong feelings of iesignalion to yet further unavoidable suffering.
LONG-TERM PSYCHOLOGICAL SEQUELAE
ll'ur neuroses
In the 1940’s controversy focussed upon whether the acute post-traumatic neurosis
of war was determined by a constitutional predisposition, by the trauma itself, or by
some combination of these. Brill and Beebe [72] studied 1000 men with acute traumatic
neurosis an<J found that the only factors which correlated with it were low educational
level and stress of combat. If units in battle were defeated and cut off, break-down
was universal. This was called “battle fatigue” or “combat exhaustion” and it
occurred in willing, stable soldiers who had made an efficient adjustment to battle in
units of high morale. Swank [73] in his study of combat exhaustion in over 4000
survivors of the Normandy campaign, found that all soldiers became incapacitated
after approximately 75 per cent of their companions were killed. Reid [74] found
446
Warren Kinston and Raciifl Rosser
simi'.ir results in studies of bomber crews in the U.K. Acute traumatic neurosis and
coir bat exhaustion are similar stereotyped reactions which involve symptoms of
emotional tension (anxiety, insecurity, nightmares, excessive startle responses,
phobias), cognitive impairment (apathy, poor memory, preoccupation, retardation,
confusion), somatic complaints (chiefly headache, gastrointestinal distress, backache),
and rarely, conversion phenomena (ataxia, stuttering, weakness, anesthesia). Swank’s
account is unusual in noting the polarization of the attitudes of the doctors who
tended to assume either that all the soldiers were neurotic, otherwise they would not
have broken down, or that they were all stable, otherwise they would have been
previously excluded. The treatment regime included rest, sedation, ventilation of
anxieties, abreactions, narcosis and rapid return to the front.
The general belief seems to have been that the incidence of acute traumatic neurosis
was relatively high compared to that of chronic traumatic neurosis. However, this has
not been confirmed by long-term follow-up studies. Lidz [75] studied those involved
in the Guadalcanal evacuation and found that every survivor subsequently developed
neurotic symptoms in civilian life. Futterman [76], in a study of ex-servicemcn 5 yr
after me war, found many unsuspected cases of post-traumatic neurosis. Archibald
and Tuddenham [77], in a controlled study of a group of victims of acute traumatic
neurosis 15 yr after the acute episode found, that 70 per cent suffered from chronic
traumatic neurosis, the majority having acquired additional symptoms. One-third
were unemployed and one-third were in unstable employment The relationship
between stress and physical illness is well documented unci has been sh. wn to be
quantifiable. The incidence of organic drca>c in the affected populatiin would
therelb'? be predicted to alter following disaster, as a long-term elTcc . In 1954 the
U.S.V.A. National Research Council studied mortality rate and illness incidence in
S000 soldiers in the 6 post-war years. They found gio-^ differences; die prisoners of
war having a higher morbidity and mortality than combat veterans and those in
Japanese camps being more severely affected than those in European camps. This
was thought to reflect the relative degrees of stress.
As yet there is no literature available on long-term consequences of brief stress
reactions. For example, large numbers of persons suffered acute reactions during the
Lon dor air-raids for which their only, and apparently effective, treatment was tea
and sympathy from the wardens, and these have never been traced and studied. An
investigation oi psychiatric and physical symptoms in such a group would not exclude
more subtle sequelae such as changes in attitudes in patterns of emotional response
and in beliefs. All these are related to a person’s capacity to lead a constructive life,
to have some inner contentment, to be a loving parent and so on. Ernest Jones
estimated that only 8 per cent of soldiers who lost a leg developed a “normal” response
of resignation and acceptance [78]. Kardiner [79] described chronic traumatic neurosis
as an alteration of the concept of self and world and a constriction of the life space.
In the literature on survivors of the concentration camps and of the Hiroshima
A-bomb mental adaptations are examined in detail.
Nazi concentration camps
The concentration camps caused “trauma beyond the comparable and conceivable” (Eissler [80}).
The features of the stress included continuous threats of death and torture, separations and humiliation.
All drives except hunger had to be suppressed. Extreme cruelty had to be witnessed and endured,
and no expression or altruistic response was permitted. Rules were capricious and contradictory and
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Disaster: Effects on mental and physical state
447
coping behaviour was often less important than chance. The reactions of the victims were cither
apathy (the Mussulmann state) leading to death, or the “camp mentality’’ characterized by irritability,
egotistic behaviour, envy, absorption with food, lack of compassion, absence of sex drive and
familiarity wi’h death. There has been only one detailed study of the concentration camps: Kogon’s
Der SS Stadi ,n 1947 [81 J. There was very little literature on the victims for over 15 yr after the war
and then in the early 1960's studies appeared from Israel, Norway, Germany and the U.S.A. (82-87].
The literature is now extensive.
1 he typical response has been variously called the concentration-camp syndrome, the pusl-KZ
syndrome, and the survivor syndrome, It consists of emotional tension (anxiety, phobic fears,
hypochondriasis, nightmares, insomnia, excessive startle response), cognitive impairment (poor
memory, preoccupations, loss of concentration), psychosomatic complaints, heightened vulnerability
to stress, chronic depression with guilt and isolation and disturbed sense of self-and body-image.
Thus it closely resembles post-traumatic neurosis. The syndrome is chronic, severe and resistant to
treatment. Chodoff (88] describes the two sets of attitudes typical of concentration camp survivors
following the failure of (heir post-db:tstcr utopian dreams: either s. Jusivcncss, apathy, helplessness,
passivity, l.italr in md dependency,
suspicion, hostility, mistrust cynicism and a quiet bitterness
or quarrelsome bellii’crencc.
li e aetiology has been c 'vii-ivcly inxc'-'ivated, pitticularly in Norway. One of the more icccnt
leports by .St i uni |-'4 de.sci.ocJ a detailed study . i 227 non-Jcwidi Norwegian survivors of the
concentration camps. In only 10 was there evidence of psychiatric illness prior to imprisonment,
wheieas 223 had symptoms at the time of examination. This could not be attributed to picviously
opeiatoc social or psychological factors. The ncuiopsychiatiic picture was due to both psychological
stresses and-organic brain damage and the symptoms caused by each of these two factors were found
to be separable.
I: is widely recognized that these patients avoid tieaiment: of the 1,000 cases studied by Grauer
[90] only 10 were pi epared to return for free psychiatric help. Many victims make a paradoxically
good overt socio-economic adjustment [91],
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■<
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fne must detailed • • .idy of the internal vvoi Id- of long-term pusl-dis.isu • survivors is that of Lifton
in lliu’-.hima (2|. He ucsciibed the painful immediacy and intense emotion which accompanied the
re-creation uf the event by the sun Ivors. This is similar to the responses of survivors of the concentra
tions camps. It was "an indelible imprint of death immersion which has formed the basis of a perma
nent encounter with death, a fear of annihilation of self and individual identity along with the sense
oi having virtu..:'y experienced the annihilation; the destruction of the non-human environment, of
the field or context of one’s existence and so of one’s bcing-in-the-world, and replacement of the
natural order of living and dying with an unnatural order of death-dominated life.” The hibakusha
(survivors) sutler a profound emotional disturbance which affects almost all aspects of their life, so
profoundly that they seem to have become a different category of being. Lifton emphasized the
importance of the concept of the “survivor", one who has come into contact with death in some
bodily or psychic fashion and has himself remained alive. T he surv ivor seems to be unable to conclude
that it was logical and right for him and not others to survive, and is bound by a conviction that his
survival was made no-siblc by others deaths. Gu ll ..nd shame over survival priority developed very
i.q»idly after 1 I1,.'
ua. and ,«s m concentration camp v icums it has been intense and persistent.
The hibakusha -..on to be living a life of grief, mourning for family, anonymous dead, and things
(houses, streets, personal objects) which are lost sy mbols of their former self. The dead seem to be
always with them. The living identify with the dead and remain preoccupied with the inevitable
incompleteness of this process. They fear the dead, need to placate them, and submit to their moral
arbitration. Lifton construed the train of thought as: “1 was almost dead. . . I should have died. . .
I did die or at least am not alive.. . or if I am alive it is impure of me to be so. .. anything which I
do which affirms life is also impure and an insult to the dead who alone are pure. .. and by living as
if dead, I take the place of the dead and give them life".
The victims are victimized. Although they are eligible for extra benefits, they are discriminated
against socially and in business. This is reminiscent of the conflicts that emerge as the post-disaster
utopia collapses. The hibkusha crave special care and nurturance, which they then perceive as
insincere, humiliating and unacceptable. Consequently they become intensely resentful. They also
show survivor paranoia and survivor exclusiveness (“we who have been through it are different”)
which disturb social integration. The non-hibakusha have attitudes towards the hibakusha similar to
those that the hibakusha have towards the dead, i.e. fear and guilt. They are ‘‘survivors once
removed”. This leads to the tendency to cast out the tainted (the hibakusha), and the response of
honoring martyrs while resenting survivors.
Formal psychiatric illness is not common. Psychosomatic illnesses are prevalent and hypo-
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4-tS
Warren Kinston and Rachfl Rosser
chondriasis and “neurasthenia” are usual. The hypochondriasis is associated with ideas about cancer
and fears of death and dying, and the neurasthenia is manifested by vague complaints such as fatigue,
irritability, sensitivity to weather, difficult) in coping, dizziness, malaise and depression.
Lifton suggested a mechanism of mental adaptation to the psychological impact of disaster. Death
annihilates at the physical level (bodies, houses) and mastery is required of this death immersion.
Ji also annihilates at the psychological level (friendships, life cohesion). The hibakusha must work
firstly to emancipate himself from his bondage to the dead, and secondly to re-establish himself
among the living. A process of the formulation of the relationship of the self to the world is necessary
for this Positive formulations involved "non-resistance” which enabled the survivor to absorb the
losses and "sacrifice with a sense of special mission” which enabled the survivor to justify the con
tinuation of his life. Negative formulations involved imagery of break-down, revenge, bitterness and
continuous strife, which tended to generate more guilt and anxiety. When guilt and anxiety were
excessive, they hindered the development of any formulation and this resulted in further difficulties
in adjustment.
For many years the experience was relatively intractable as a subject for symbolic transformation
in art. The principal factors interfering with the creative response were the guilt and anxiety associated
unh conflicts between literal and artistic truth, and the resistance of the subject to integration within
the wider human framework of death and survival. However with the passage of time, works of art
which do seem to encompass t.'ie experience have appeared.
MANAGEMENT
•There is evidence that specialized psychiatric skills could be useful in all phases of a
diAister. However, psychiatrists are rarely called upon and their intervention is
actively resisted in the early phases by other helpers and in the late phases by the
victims themselves. Although a significant proportion of persons may be disturbed in
the ac.:*e phase, it is not clear what priority should be assigned to psychiatric help
relarr . rn other relief. In the Ancash carinquake psychiatrists were summoned
urgently as it became apparent that psychiatric complications were hindering other
.care [18]. In more developed countries this should be feasible as a routine and in
Jugoslavia, for example, the psychological impact of disaster has been considered in
planning relief services.
In the acute phase, 10 per cent of the population may be so disturbed as to require
specific intervention such as rest, removal from the site, physical restraint, sedation
and personal attention. The commoner later complications are grief or depressive
react’d.? post-traumatic neuroses, and transient emotional disturbances in children.
Those most at risk arc the bereaved, injured and children separated from their parents.
General supportive therapy along simple psychotherapeutic lines is the usual approach
and provides at least temporary relief. Apart from the orthodox methods of individual
treatment, there is little information on the special problems of treating communities
where death, disablement, material loss and bereavement are prevalent. The com
munity response may be therapeutic, aggravating or both.
Barter 'S' has produced a model of the factors, individual and collective, that may significantly
affect Lie community response and he suggests that the community as a whole, as well as individuals,
must be a target for management. For example it is important to be aware of the significance of the
media in both aggravating and ameliorating the individual’s psychic distress. An obvious role for
psychiatrists would be to set up groups to work through the community’s shared experience in a
constructive way. Victor Frank! (92,93] attempted constructive psychological work of (his kind within
the setting of continual massive psychic assaults in the concentration camps.
Hocking concludes his review by stating: ‘‘If extreme stress is prolonged, break
down is universal, once this occurs removal of the stress may result in only a temporary
improvement, the individuals are left with an impaired capacity to adapt to everyday
life including the physical and psychological stresses of ageing” [1]. It is not clear
whether treatment can reduce the amount of disability. A major problem in psychiatric
.-V
Disaster - Effects on mental an J physical state
I
449
treatment is firstly, the reluctance of the victim to recognize his need for help, and
secondly, the reluctance of the psychiatrist to acknowledge the need.
Krystal [94] showed that the allocation of restitution payments from Germany was a function not of
diagnosis or psychosocial state but of the centre in Germany where the case was handled. He found
that even when sickness was ii'enlilied it was rarely treated: 31 of the 697 potential patients received
treatment. In Japan, Lifton estimated that 10 20 per cent of the hibakusha are still unregistered, and
although political pressure has resulted in gross, and largely gratuitous, extensions of medical benefits
to hibakusha, the existence of mental illness as a consequence of the A-bomb is not accepted.
,
’
•'
>
The main source of information on the outcome of the treatment of the chronic
complications of severe stress is the literature on the survivors of the concentration
<
camps. The treatment has generally been psychoanalytic and there is controversy
about its ctlicacv.
■
j *
I
De W.iid [95| cl.ii.ii. that massive st i css is neither ,m indication not a r.>iiiiaii)Ji.;i(k>ii l<» liirtapj.
ii.-acMi. he list-, in.my -.pceitic diiliculiicb including the formation of a delusional transference,
a'.lcct lameness and dread ol ailccts, .somatization, special countertransferencc problems, survivor
. h p'Vvhtihnj' reeo^cy. loss of b.r-ac trust, inability to tcali/c that aggressive wishes arc not omni• a.«.'cc-sixc guilt ovet enjoyment of sado-ni.uochistic gratification, and the use of the experience
:
as a tcsbtance to the resolution of the infantile neurosis. On the basis of 22 cases treated with psychoanalysis and others treated with psychotherapy, he concludes that the pathogenic influences of the
experiences may be relieved and once again it can become possible for a victim to lake his existence ‘
for granted apd to feci that the world is a safe place.
;
i
!
I
A possible beneficial effects of a community response in the long-term has been
I
demonstrated in Israel.
The kibbutz provides a secure psychosocial milieu which probably facilitates integration and
sx-lf-acccptance with a possibility of new identity formation, and the country has special museums.
periodicals, occasions cl public mourning and so on. Community efforts of this kind might also
minimize the second •’ci’cration elk. is which arc well documented [96]. 2 he children are psychologic
ally comparable to il- we whe.c parents have had massive deprivation in their childhood. This
cultural “working th;.-■ah” sc. ns to be both a spontaneous and purposive development in many
countries which have been tavaged by civil war. It lakes the form of continual reminders of the
struggle and reiteration of its value and of the heroism of those who suffered, expressed in the media,
arts and public works.
PREVENTION
Primary
The psychological dice I of warnings in terms of social action is discussed by Janis
|97j. The problem is one of the human capacity for vigilance, and the tendency to
become hyper\ igilam. or. more usually, io adapt. Because of this extensive use of
deni.d. psyclii.t'-:>'.s might have a role in alerting the public. Some kinds of disaster
are almost completely preventable.
Psychological work must be done to minimize the psychological impact of disaster.
There is agreement that a qualified rather than total belief in immunity and the
absence of disaster constitutes a favourable condition for withstanding an extreme
event. There must be an admission of the possibility of occurrence yet a belief in
survival. In admitting the event to consciousness, Janis refers to the work of worrying.
Anticipation is a small scale preliminary exposure on the level of imagination and
can have an inoculating effect. By rehearsing and familiarizing oneself with the
coming event one may reduce the risk of being overwhelmed by the experience.
In the Bengal famines of 1943 and 1971, the notable feature was the refusal of the governments
(British and Pakistani, respectively) to do this (21). However Janis gives examples of the ill-considered
and highly charged emotional reactions which develop with the forcible breaking down of denial [98].
Jacobson [25], describing the various individual and interpersonal crises which developed in a large
group of passengers confined aboard a sky-jacked plane, commented on the “normal” response of
icfusal to accept emergency, threat and crisis. She suggested the exploitation of normal life crises
(
li I
J
If
i
450
Wakrfn Kinston and Rachel Rosser
and the use of non-insight oriented encounter groups to provide people with an acquaintance with
their own feelings and responses to threat.
Secondary
The most important aspect of psychological care is the social provision of physical
care: i.e. physical care z.y psychological care, and this is the prime and essential function
of relief organizations. General psychological first-aid should be understood by all
responsible personnel involved in disaster relief. It involves fundamentally the
establishment of effective human contact with those who are disturbed or upset. The
principal requirements arc for personnel to accept every victim’s right to have his own
Iccliiit’s,
accept the victim’s limitations as real, and to accept their own limitations
199].
A vaiicty of social !.i<tor> which influence psychological rccowiy have been identified |9], It is
essential that local go\c;nmcntal bodies and relief organizations are aware of these. Separations of
loved ones tpaitxtilaichildren from parents; are traumatic and every effort should be made to
prevent them. 'I he confusion, anxiety and guilt can be minimized by accelerating the natural processes
of reorientation and reidentification; leaders arc needed, lists of dead and injured arc necessary, the
establishment of effective communications and centres of information is important, and the spread
of rumours must be halted. Competition between relief organizations must be rapidly dealt with.
In addition to the fundamental physical, psychological and social approaches to
relief, specialist psychiatric care is requited for acutely dislurbed victims. Their
prompt treatment may be essential for efficient operation of other services, and may
have a favourable elfecl on the long-term prognosis of those affected.
feriiary
Work.- e through at the individual and group level is an important aspect of the
ultimate acceptance of the event and its consequences: and it may also aid in the
development of constructive altitudes and efforts. Psychiatric treatment, rehabilitation
and general community work may also be needed [7, 79].
PLANNING SERVICES
To outline a plan for an ideal psychiatric disaster relief service, it would be necessary
to predict the approximate number of psychiatric casualties of different tv pcs and to
calculate the amount of p\\chiatric manpower required al various times after the
event to handle this. 1 his involves the following methodological problems. (1) The
lack of tools to measure the prevalence of treatable and unbeatable psychiatric
morbidity in a community. (2) The lack of control groups and “before and after” data
for disaster: a disaster is unpredictable and most routinely collected data reflects
nosocomial factors which are changed by the crisis rather than true morbidity.
(3) Lack of information on the effectiveness of various psychiatric techniques.
Quantitative data is currently available from the various studies described earlier in this paper.
The literature on life crises and their relation to mental and physical illness provides models from
which further deductions can be made about morbidity following a disaster. A variety of studies
[100-105] have compared the number of stressful life events preceding mental illness with that in
control groups. Brown ct al. [100, 101] in an important group of papers have examined the relation
ship between life events and subsequent mental illness. They conclude that severely threatening events
may be formative in depressive illness and may trigger schizophrenic illness, and that depressive
illness may also be triggered by milder stresses. Cooper and Sylph [105] suggest that severe life events
may cause neurotic illness and milder events may precipitate them. Using the experimental data of
these workci's, the incidence of depressive illness in a disaster-struck community could increase by
Disaster : Effects on mental and physical state
451
350 per cent and that of unspecified neurotic illness by 1100 per cent. Of the unspecified neurotic
illness, 30 percent would be assumed to be substantially earned by, rather than precipitated by, the
disaster. This group at risk might be relatively more difficult to identify. Brown ct al. wrote “our
li'rmulalion of the problem is based on the explicit assumption that vulnerability to events varies
with the spontaneous onset rate which may be interpreted as the degree of latent psychiatric disturb
ance” and “nor is it reasonable to reach any sort of final conclusion about the proportion of patients
involved in a total environmental effect” (which could be a disaster, for example) “without a complex
analysis which takes account of a whole range of other possible social influences”. We suggest that
their model might be extended to examine data on the psychiatric morbidity following disaster and
elaborated to define factors which affect the degree of latent disturbance in an individual which might
be useful in identifying those at risk (our reading suggests that age, previous psychiatric history, and
ethnic isolation would be important), and the immediate and delayed effects of the total community
experience and the type of disaster on the relation between events and illness.
Thus the incidence of illness reaches a maximum shortly after the disaster and is
compounded i r caused illness, precipitated illness and illness which would have
ocelined al that lime anyway. The incidence then falls slowly to below normal for
the population, relieving the premature occurrence of precipitated illness, and
eventually returns io normal. The prevalence will of course persist above normal
reflecting the existence of long-term complications. To predict the amount of man
power which can be productively introduced into the area, data is required on the
uUcciivcncss of intervention. This urecntlv• needs investiualion.
Until it is clarified no
*definite'conclusions can be drawn regarding the relative priorities of psychiatric.
medical and other relief services in situations of limited resources. We would make
the following suggestions for present-day practice:
(1) A psychiatrist should visit all major disaster areas in the first few days after the
event and should advise on first aid and on the psychiatric services which arc likely to
be needed in the immediate and longer term future. This judgement will clearly be
related to the normal standards of care available in the area.
(2) A world-wide register of psychiatrists particularly interested and experienced
in the various aspects of disaster should be set up. These might advise as expert
consultants to regional psychiatric centres.
(3) Teams of psychiatrists and auxiliary personnel should be available for integra
tion with the general relief response in areas where there are no developed psychiatric
services.
GENERAl DISCUSSION
Disaster and the c<>rcepi td’disease
Much of the controversy in documenting and in managing the psychiatric sequelae
of disaster is a reflection of the confusion between a variety of different models of
illness, such as the pathological, the statistical, the sociological and the psycho
dynamic. This discussion considers some of the consequences of this confusion. A
major problem in describing human behaviour in psychiatric terms is its definition
as normal or abnormal in the context of a particular model. The study of a disease as
a specific entity has been heuristically convenient, but it must also be understood by
the clinician as a state of being, a dimension of the person's way of life [106]. Engel
and others have used grief as a model for this approach [107, 108].
Responses to stress: psychodynamics
The concept of the continuity of disease process is related to the fact of the con
tinuity of stress. It is not clear exactly what mental processes are involved in sustaining
452
Warren Kinsion and Rachel Rosser
and dealing with stress, in “coping”, “surviving”, or “getting over it”, nor what arc
the mental sequelae.
Physical stress and psychic trauma cannot be equated because psychic trauma is not so much
determined by the physical intensity of a situation as b> the meaning and affects evoked in a particular
individual. Any experience which provokes distressing effects (fright, anxiety, shame, physical pain
etc.) is potentially traumatic. The essence of the traumatic situation is an experience of helplessness
on the part of the ego in the face of the accumulation of <juch internal excitation (109). Thi» is universal
in infancy, but rare in adulthood; however a disaster can be just such a situation. What is threatening
to a particular person depends on the amount of psychic pain and painful affects he can tolerate;
with maturity and emotional development this tolerance increases [109, 110],
In children, “developmental studies have demonstrated that trauma may result,
nut only in the fixation of defences and inhibitions, but also in the disruption of ego
capacities and the narrowing of the range of techniques and patterns of behaviour
available for dealing with objects and with the environment” [111]. This is closely
comparable with Kardincr’s description of the psychopathology of the adult with
chronic traumatic neurosis [79].
A. distinction may be made between the single massive experience (shock trauma)
comparable to the acute disaster, and the accumulation of difficult experiences (strain
trauma) comparable to the chronic disaster. In the latter case a variety of accumulating
tensio: < and affective states results in an increasing state of ego strain, and eventually,
as the adaptive responses fall, a strain trauma, with the subsequent development of
new' ego organization to preserve a feeling of safety [112].
Many writers [7, 90. 94] emi hasi/.c ,h it the psychopathology during and following prolonged
slates of disaster is to be understood as a real.? 'dented adaptation (albeit to the abnormal reality
of the disaster situation) rather than as attempts to benefit from secondary gain, t-r as defensive
regressions to ward off rcacti’.uted inner conll cis. Oil er work [2. 94. !I3j si.egv'ts mat one of the
fundamental ai.d more obsiocs alterations in an adult subjected to sewre stress is in h.s formulation
of existence. With increasing age, formulations may take on a negative pessimi-' _• diminishing
quality [32, 72, 114].
Classification d‘responses to Stress
Although evidence shows that disaster alters the affects, ideas, attitudes and
physical health of those exposed, there is not much literature contributed by organic
ally-oriented psychiatrists. The reactions are often not functionally disabling,
somatization and real physical ill health leads the patient to general ph\sician>, and
lew \ic*; ' s present as psychiatric patients with fuimal abnormalities in their mental
state. B\ connast li.c psychoanalxticall)-oriented psychiatrists find a plethora of
symptoms and often severe pathology. They claim that this discrepancy arises because
when the psychiatrist is experienced as unreceptive, emotional catharsis is inhibited,
and the patient retires into a defensive isolation and takes up a posture of health.
Where psychiatric disturbance is overt and less disputed, it is often difficult to accom
modate in existing taxonomies. Roth takes some of the more severe reactions to
disaster as examples of syndromes falling outside the traditional division between
neurosis and psychosis [53]. The typical stress response known as post-traumatic
neurosis, post-KZ syndrome, and combat exhaustion has been relatively clearly
delineated but is not recognized in the International Classification of Diseases as a
separate diagnostic category. Attempts to assess the psychiatric morbidity in the
survivors of concentration camps in traditional nosological terms resulted in the
improbable conclusion that the incidence of mental illness in this group is lower than
that of a control group [115].
Disaster : Effects on mental and physical state
453
The (k\c of the survivor [2]
Langer [116], in a review of historical studies of the great plagues, postulated the
aggregate effects of psychological trauma as the mechanism whereby disaster brings
changes in a society or culture (also cf. ref. [11 7|). fallowing the Black Death there
was an age marked by misery, depression, anxiety and a general sense of impending
doom. The plague \\,b a chronic frightening threat about which nothing could be
done. However, today we both expect and demand survival; society admits the
narcissistic entitlement, the right to survive.
Whether we face the traditional disasters such as natural disaster, economic
disaster and disasters involving deprived minorities, or the more modern disasters of
o'.eipopul.i'ion and environmental pollution, our clow contact with them in a world
shrunk and ; •?<!c cnn-li* imllv mimcdi.ite b\ tele-. i*t\ ii-^ilvlhic communication turns
:.•> .di into bom p;n ticipants and ■ ixc: As such the sequelae of disaster discussed
,
.
'
m Inis paper arc rclcx.n.l to Us ah.
•
9
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89. Editorial. Late effects of torture. Lancet 2, 721 (1968).
90. Grader II. Psychodynamics of the survivor syndrome. ( an. Psychiat. Ass. J. 14, 617 (1969).
I. Osivv.aLD P. ;.nd Bit inlr E. Life adjustment after ••were per.cculion. Am. J. Psychiat. 124.
1393 (1968).
92. I ran Kt. V. [ . .'Jan’s Search f<>. ,\R naiy. In Introduction to l.oyothcrapy. Beacon Prc^s.
Boston (l%2).
93. f-RANKL V. E. Psychotherapy and Existentialism. Souvenir Press, London (1967).
94. Krystal IL and Niidiri and W. C. (Eds.). Psychic traumatization after-effects in individuals
and communities. Ini. Psychiatry Clinics Vol. 8, Little Brown, Boston (1971).
95. de Wind E. Persecution, aggression and therapy. bit. J. Psychoanal. 53, 173 (1972).
96. Sigi l J. J., Sivi r D., Rakom V. and Ellen B. Some second generation effects of survival of the
Nazi persecution. Am. J. Orthopsychiat. 43, 320 (1973).
97. Janis 1. L. Psychological effects of warnings. Baker G. W. and Chapman D. W. (Eds.) op. cit. (61).
98. Janis J. L. Air H'ar and Emotional Stress. McGraw-Hill, New York (1951).
99. Drayer C. S., Cameron D. C., Woodward W. D. and Glass A. J. Psychological first-aid in
community disaster. J. Am. Med. Ass. 156, 36 (1954).
100. Brown G. W.» Sklair F., Harris T. O. and Birley J. L.T. Life events and psychiatric disorders.
Part 1: Some methodological issues, Psychol. Med. 3, 74 (1973).
101. Brown G. W.» Harris T. O. and Peto J. Life Events and psychiatric disorders. Part 2: Nature
of the casual link. Psychol. Med. 3, 159 (1973).
102. Paykel E. S., Myers J. K.» Dienflt M- N., Klee man G. L., Linderthal J. J. and Pepper M. P.
Life events and depression. A controlled study. Arehs gen. Psychiat. 21, 753 (1969).
456
Warrln Kins ion and Raciill Rossi r
103. Cooper B. and Shepherd M. Life change, stress and mental disorder: the ecological approach\
In: Modern Trends- in Psychological Medicine. Price J. H. (Ld.) VcL 2, pp. 102-130. Butter-'
worths, London (1970).
104. Parkes C. M. Psychosocial transitions: a field for study. Sue. Sci. Med. 5, 101 (1971).
105. Cooper B. and Sylph J. Life events and the onset of neurotic illness: an investigation in general
practice. Psychol. Med. 3, 421 (1973).
106. Wolf S. Disease as a way of life: neural integration in systemic pathology. Persp. Biol. Med. 4,
288 (1961).
107. Engel G. A unified concept of health and disease. Persp. Biol. Med. 3, 459 (I960;.
108. Engel G. Is grief a disease? Psychosum. Med. 23, 18 (1961).
109. Freud S. Inhibitions Symptoms and Anxiety (1926). The Standard Edition of the Complete
Psychological Works of Sigmund Freud. Vol. 20, pp. 77-175. Hogarth, London (1959).
110. Freud S. Beyond the Pleasure Principle (1920). Ibid. 18, 3 (1955).
111. Furst S. S. (Ed.). Psychic Tr.auma. Basic Books, New York (1967)
112. Sandli r .1. J. FurstS S. (Ed.) op cit. i116).
113. Cat it S. Beyond depression • the depicted stale. Cun. Psvehiaf. .!••. ./. 11 (Suppl. 5j. 329 (1966)
114. Modi.tx JI. (‘ 'I he post-a^cdent anxiety syndrome: psychosocial aspects. Am. J. Ps\chiat.
123. IO<>S (|9(><’j
115. Strauss 11. Psschic disluibar.Ces in \ictuns of racial persecutions. Prue. Second b or'd Cong.
Psychiat 2, 12u7 (1961).
116. Langer W. I. The next assignment. Am. Hist. Rev. 63, 283 u >58).
117. Sjouirg G. Disasters and social change. Baki r G. and Chapman D. (Eds.) op. cit. (61).
p/V]
2 Ndwn KB. Hlenhcrg JH rred’<»orxe(cpikrxv m<hik!r<n who hu*c experienced febrCc xcirirn
XE^lJMcd
1029 H
3 Nciwn KB. Elknbcri JH Progn.-xu m children with icbnle vuurei /V/xrmuf P’1.41 *?> *
4 Annegen ]F. HautcrWA.ShiruSR. Kurland LT Fauen rn'<n«'ir:<<'f unpnnrkrd wuu/o
febrile cnnvuhionx X Engl} .Ma! 1937.)!6 491 4
5 Onnxtcd C. Lmdux J, Norman M Bhdc^ua! fa^twx ir rv-'f'.'rai L'6<
Locutal ^pnr<.»
S<Kic(y *ilh Heinemann. 19*6
6 Falconer MA (knetic and related acttologKil fatcri in temporal lobe cpkpi 4 roiew £;«//* ,t
1971.1213-31
7 Rnbinmn RJ Febrile cnnxulconx Gwv’r Hcrpfj/197 J.122 4)-J t
* Newton RM’ Rand^mued ccntrnlled tnahofphencbarbironc and vaJpfxitc in febcikccntuhR ri
An A Du Child I9SX.6J 1189 91
9 McKinbv 1. Newton R Intention m treat febrile con*uhivn with recrat diaaepim. vifevare • e
phenobarbitone. Dev .WeJ Child Arw I t'^M.il M7-25
n Kirad« f V Ininmitient dia/cpam prophylaxis in febrile convuliioni: pro* and coni. Acta'
XnrtiSivd |991.DSiWrTl > 1-24
11 Jenai VTcetang Group cd the Rexarch Unit of the Royal College of Phyxkiani of London and the
Rjr.juh raedauxe Av«iat>on. Guideline* for the management of convuliioni with fever. BMJ
199J.W 6M6
12 MeHrom B$ iocondarr pathology of febnie and eipmmenla1 pnvultioni. In: Brazier MAB.
CcKtxsi F. rdi. fkeni At/wara iw trannie febrile rcmtidiiORi. New'York: Raven. 1976:213-22.
3 J \ ixxura RC Meubolx and pathological conkcquencei of experimental febrile seizure* and itatus
cpikp'.ian In Nclrco KB. Ellenberg JH. edt. Febnleinrvrn. New York: Raven, 1981:43-57.
D
O. Burt e I. FhiDipi J, Murphy S. O'Moore B. Staunton H. rr al. Microdyigeneiis in
retereJ temporal rxotoerr incidence and clinical significance in focal epilepsy. Nrvro/ogv
MLW l(M|-7.
I1 U aZlKvSj T Ar (W/unxAfeFnlr innrn London. John bright, 1988 81,126.
• FROM BMJ VOL 303 M> N(>Vf:MBF.R 1991. 1345-1346)
Rescuers’ psychological responses to disasters
Rescuers need support as well as victims
Many people other than (he primary victims may be affected
psychologically after a major disaster.1 Despite their training,
emergency workers may fall victim to stressors created by the
work they have to do. The findings of an early study after a rail
crash in Sydney have been confirmed many times —that over
70% of rescuers may experience transient symptoms of posttraumatic stress: nightmares, anxiety, and flashbacks/’ In
most cases these settle, and indeed in 35% of the workers in
Sydney more positive feelings about the value of life emerged.
Nevertheless, in some the distress does not settle and severe
morbidity develops. Valuable research has been done to
clarify, the impact of disasters on rescue workers and suggest
ways of preventing long term morbidity.
During rescue operations workers may confront scenes (hat
bring physical revulsion, even vomiting; transient physical,
emotional, and behavioural reactions are common. Some
times when confronted with overwhelming trauma or the
strangeness of foreign cultures rescuers may feel helpless and
retreat from or misinterpret what they find. On the other
hand, the excitement of involvement may generate a "high,”
which mav extend to overinvolvcment and a sense of
omnipotence — the counterdisaster syndrome.
Ihe most sensitive indicators of continuing impairment arc
cognitive impairment and disturbed interpersonal relation
ships as well as increased arousal, irritability, and loss of
interest or withdrawal. Workers may resort to excessive
drinking in an effort to forget or dampen distress or to sleep.
Marital and family relationships often suffer, and families,
especially spouses, may also need support, particularly if the
worker remains locked into his or her experience.
Characteristics of the disaster, the rescue operation, and the
rescuer himself may all affect the degree of stress experienced.
For example, gruesome tasks, particularly when there are
multiple deaths, mutilated bodies, or the deaths of children,
are stressful for most workers. Even trained body handlers
were stressed by recovering bodies after the Mount Erebus air
disaster, with a quarter still showing stress 20 months later.’
Similarly, after the mass suicide in Jonestown experienced
servicemen were distressed by the large numbers of dead, the
rotting bodies, and the futile deaths of children.’
KIH6
Emergency workers are as susceptible as any others to
ordinary work related stress arising out of organisational or
management issues.' A massive disaster is likely to aggravate
many of these and provide an additional psychological
burden.
Conversely, careful organisation and management may be
powerful antidotes to stressor effects.6 The police who helped
retrieve bodies after the explosion on the Piper Alpha oil rig
were provided with detailed induction to their (asks, explain
ing the importance of what they were doing, their possible
reactions, and (he need to attend to their own welfare. They
worked in pairs with an older, experienced officer in each,
their shifts were limited, they were debriefed each day, and
informal support was available from a psychiatrist. They
showed no long term effects from their stress. Even when
stress is experienced at “caseness” levels by disaster workers,
as in the fire at Bradford football stadium, brief counselling
sessions can facilitate recovery.7
From their extensive experience with disasters in the
United Kingdom, Hodgkinson and Stewart have identified
personal loss or injury, encounters with death, and ‘‘mission
failure” as the primary stressors for rescue workers.1 Frustra
tion at lives that cannot be saved, failure of equipment,
delays, and overwhelming demands all contribute to psycho
logical distress. Symptoms may reflect this conflict, .with
guilt, reconstruction anxiety, general irritability, focused
resentment, and loss of interest in work.7
Personality characteristics also affect rescue workers*- vul
nerability to stress. Simply being older and more experienced
in itself is protective. ‘‘Hardiness’’—a sense of commitment,
challenge, and control —is a protective personality style for
many workers.* Coping styles that emphasise sharing prob
lems, constructive use of humour, and the use of social
support also seem to be helpful.1 Conversely, those who are
drawn to action but deny their vulnerability will find it
difficult to admit to stress or seek help. Fear that workmates
will think them inadequate or that their career prospects will
be damaged are the commonest reasons for distressed workers
not taking advantage of stress counselling. Among volunteer
bushfire fighters in Australia neuroticism and past psychiatric
SELECTIONS FROM BMJ
vol. 7
February 1992
a
disorder have been found to contribute to the development of
post-traumatic disorder, particularly at lower levels of stress.*
Like the police, medical and hospital workers are often seen
as immune to stress because of their training. In fact, they arc
equally likely to be affected but may not have access to
support programmes. Studies of debriefing programmes
provided after the Hillsborough disaster, where 95 people
were crushed io death, showed that hospital staff could
benefit: 139 out ol 205 people attending debriefing pro
grammes found them helpful, though some did not. Those
who remained distressed six to nine months later had had
higher levels of exposure, showed more distress symptoms on
systematic measures, and were concerned about personal and
organisational performance. Nevertheless, as with other
rescuers, an appreciable minority found the experience
positive, with a renewed appraisal of the value of life.”
I'hc increased interest in the reactions of rescue workers
has been accompanied by the development of programmes
such as critical incident (or stress) debriefing. This is usually
provided in groups by mental health professionals and peer
support workers in the first 24-72 hours after the disaster."
Anecdotal evidence suggests that it is effective, though no
controlled trials have been performed. Clearly also it should
be only one part of a range of organisational, educational, and
support responses.
Emergency organisations need policies that identify stress
ful circumstances and teach their staff to cope with them.
1 hey should also provide an effective safety net of debriefing
and counselling when disasters occur. The support should be
based on the expectation that workers will master their own
stress. I’he aim is to help the worker through his or her
experience to a “good enough’’ retrospective integration of it.
When this policy fails workplace and health services must be
aware of the potential impact on health, the nature of posttraumatic morbidity, and effective rehabilitation. Such poli
cies of understanding and support also provide a positive
environment for the smaller disasters that confront such
workers cvcrv dav.
BEVERLEY RAPHAEL
Professor of Psychiatry
LENORE MELDRUM
Research assistant
BRIAN O’TOOLE
Senior lecturer
University of Queensland,
Royal Brisbane Hospital,
Herston,
Queensland 4029,
Australia
1 R>^N*rf B TTTm-t
imln New York Diuc Bookt. !986.
2
B.
B. Br>Jbun L. I Jimben F. ^‘bo hclpi the be! pen? The effecti of i diuxter oo
thf fFK'JC
( Hnrf □ ) 9g 1 4 J
I TriW AJW. 1 tirrt AG The tnrwi of
J
rf//S
it
J Y9 20
body handling and rktimi’ idenltfkalion.
4 12
l>R ^<\*t*njan dtKaiiri VHiimi ihr rmoiional effexli <4 rettnefing and identifying human
rrmami .4J /Bn% foam |9|$;)42 303 7.
5 Jarx-5 A rcfxrpti«iv of urrw in Routh ambulance personnel Tori and Stmt 1988^2:319-26.
6 AkuoJn DA.XCrlliA Rein*>ni of police offiern to body handling after a mayor ditifter: a before
and afia tonpinK’n H'J l*n\ hijtry 199);l$9:547-55.
?
r Pwi holt >1 probl rm i anting from dinner work Stmt Mrduw 1986;2:315-23.
I H s50-xr>uw-> J’J , Sir* an M (
rafOirnpVi A handbook of diiaiur nunafrmml London:
Roytkdrr. 199)
9 M J wlarx A( Ihe
of poll irmmanc motbuliiy: prednpming. precipitating and
popciuaitfig favittfi
J
kury 19KQJM.221-8.
Shapiro !>. XunBn J Z‘n«. hoJofi. al
hrtfnlal naff initialed by chnual piyrApA»fifh in rV
t 'u-mzzl of the IhUtbonru^h di^aurr Sheffield; Report .for Clinical Pivcholojty. Northern General
Ho»p»la1. )9^p
11 M’hSrll JT *1 hen diwiin iTnbri the critical incident turn debriefing peoceti. Journal of
I
Mede a! 5 m. ri |9gl,t 16 9
4 J
<1 ROM BMJ VOL 303 ki NOV 1 MHHR 1991. 1346 LU7i
Lessons of Chernobyl
Psychological problems seem to be the major health effect at present
The accident at Chernobyl resulted in the largest short term
release of radioactive materials to the atmosphere ever
recorded from a single source. The major radionuclides
released to the environment included isotopes of iodine,
caesium, strontium, and plutonium and also highly radio
active fuel fragments or hot particles. The human impact of
the accident has been immense. Hundreds of thousands of
rescue workers took pan in the clean up operation, more than
100 000 people were evacuated, and for many more restric
tions on activities and foodstuffs have had a major impact on
everyday life in three Soviet republics.
One legacy of Chernobyl is that surface contamination with
caesium-137 in about 25 000 km’ of land and about 2225
settlements is now at least 185 kBq/m; (5 Ci/knr), with
smaller areas having much higher levels or appreciable levels
of strontium or plutonium. Minimising (he effects of such
massive contamination will pose challenging problems to
Soviet scientists for many years. Technical problems, how
ever, are not the only ones troubling the affected areas. Social
tensions are also rife. Clearly perestroika, food shortages, and
ethnic unrest all play their part, and these have been fuelled
by inappropriate official secrecy: (he first maps summarising
environmental contamination were drafted in July 1986, three
months after the accident, but they were not published until
March 1989. Furthermore, ignorance about the likely effects
of exposure to radiation has resulted in even local doctors
attributing to (he accident a wide variety of diseases never
SELECTIONS FROM BMJ
vol. 7
previously associated with radiation. Such was the atmo
sphere of mistrust directed at the authorities and at many
Soviet scientists and doctors that the Soviet government asked
the International Atomic Energy Agency (IAEA) to evaluate
the consequences of the accident and the measures taken to
protect the population that continue to live in the afflicted
areas. These events led to the establishment of the Interna
tional Chernobyl Project, whose final report was published
last month.’
Much of the project was concerned with the health of
people living in villages 30-300 km from Chernobyl that have
appreciable caesium contamination. The report’s major con
clusion was that the largest effects on health currently
attributable to the accident are psychological. For example,
45% of people in the surveyed villages agreed with the
statement, “I think I have an illness due to radiation.” These
beliefs were not, however, substantiated by the IAEA team,
who found no differences between die contaminated villages
and nearby uncontaminaicd control villages in a wide variety
of clinical observations and laboratory measurements, includ
ing the prevalence of thyroid abnormalities and haemoglobin
concentrations. Additionally, people arc concerned about
continuing to live in areas with radialion because they feel
trapped and their children’s future seems uncertain. These
fears are reinforced by the many restrictions on eating
foodstuffsand on other activities which, ironically, the IAEA
judged to have been too extensive. Many qf the measures >
1087
February iwj
FT**•— -v
taken were unjustifiable on grounds of radiological protec
tion, while some that were worth while, such as taking stable
potassium iodide in the month after the accident to prevent
uptake of radioiodine by the thyroid, were implemented by
only about a fifth of the population.
Although the IAEA project found numerous health prob
lems unrelated to Chernobyl, it found no health effects, other
than psychological ones, that could be confirmed as directly
attributable to radiation. This is not surprising for several
reasons. The project’s remit excluded those likely to have
received the highest doses —namely, rescue workers, workers
at the plant itself, and those who had been evacuated. Only
about 1350 people currently living in the area and readily
available were included in the survey. 'I his number is big
enough to identify major discrepancies between contaminated
and control villages in the prevalence of common disorders or
in the average value of variables such as haemoglobin
concentration, but it is too small to detect a modest increase in
cancers or other serious but rare disorders. Furthermore,
many effects would not yet have had time to appear. Other
studies of the effects of exposure to radiation have found the
highest relative increase for leukaemia occurring within five
years of exposure,’ but for many other cancers increases even
five to 10 years after exposure are modest compared with
those in later years.’ Hypothyroidism may also take many
years to manifest itself.
Risk estimates based on the experience of other exposed
populations provide a rough guide to the likely ultimate toll
from Chernobyl in those continuing to live in contaminated
Ureas.* With IAEA project estimates of dose in the 70 years
after the accident and a dose rate reduction factor of 2 for
cancers other than leukaemia, the estimated increase in the
overall risk of fatal cancer is about 2-4% in the contaminated
area, with the possibility of larger proportionate increases in
the incidence of thyroid cancer and also in some cases of
hypothyroidism. Accurate forecasting is, however, difficult.
Official Soviet procedures for dose assessment often resulted
in overestimates, typically by factors of 2-3. The largest doses
are thought to have been thyroid doses resulting from
shortlived radioiodines. These had completely decayed before
the IAEr\ project, thus preventing any refinement of initial
Soviet estimates. Furthermore, although much is known
about the effects of radiation, the Chernobyl experience
differs from other events that have been studied intensively to
date: a substantial proportion of the dose w'as from internal
irradiation, dose rates were low, and thyroid doses were of a
mixture of shortlived radioiodines. In view of all these
uncertainties monitoring of the population, such as has
started in the Ukraine,’ seems desirable even though the data
may require careful interpretation.
The IAEA team found Soviet scientists and doctors battling
against a complex administration with inadequate resources,
often in isolation from recent scientific developments, and in
an atmosphere of public mistrust. They need our patience,
sympathy, and any real help we can give them.
SARAH C DARBY
Staff Scientist
GILLIAN K REEVES'
Statistician
ICRF Cancer Epidemiology Unit.
Rj Jchffc Infirmary.Oxford 0X2 6HE
r
<ij AJitu.d'i Qcr.mincr J niern3rional
txe.tJ A*
Rrojftt. An Ptrmrtr. Vienna: Inierna-
Lnerr* Apmn ,
•
SC l’* C R. GtD SK. Sznnh PG Long tern mortality after a tingle treatment couoc with
i rm s; pr.ieftu Vraird for anHIoiing ipondylitii. Hr J Canter 1987,55:179-90.
’
V.
H. khuD
Studies of the mortality of A-bomb survivon. 9. Mortality.
• >t,"‘
? Cmiw mortality hived on the recently revised doses (DS86). Radial Ret
l.'M)
£
rev m ’be B».i)nguaJ Effects of l(*nmng Radiation Health fffecti of eipotiere to tow /nv/i of
aidunnc©. 1X1 National Academy Press. 1990.
• PrmLr\ U A. Piruk OA. Buranov VA. Reeves GK. Beral V. Cancer in the Ukraine, postOirrt
1 Z. cn. fl in prrti »
MHOM IlMJ VOI. MH M) NOVI.MHI R |99|. 1.147 I.URj
Artificial blood
Mostly on the drawing board
The term “artificial blood" is loosely applied to substitutes
designed to replace the oxygen carrying capacity of human red
cells. Clinically acceptable solutions for replacing plasma
volume have been available for many years, but the quest for a
replacement to red cell transfusions continues. Its potential
advantages arc considerable — no risk of transmissible disease,
no need to cross match, a shelflife of years rather than weeks,
nd an unlimited supply manufactured on demand.
Research has focused on two main approaches: developing
synthetic oxygen carrying compounds and producing solu
tions of haemoglobin. Progress has been slow, for two main
reasons —toxicity and brief intravascular dwell times.1’
The development of genuinely artificial blood substitutes
began dramatically with the finding that submerged mice
survived in oxygenated solutions of perfluorocarbon.* Per
fluorocarbons are biochemically inert and in their liquid form
have a high solubility for oxygen, proportional to the partial
pressure of oxygen. Their main disadvantages are the need for
very high inspired oxygen concentrations (with the attendant
dangers of oxygen toxicity) and their insolubility in water.
This is overcome by producing emulsions, but these are
unstable and must be stored frozen at -20 C. Reconstitution,
Iwarming, oxygenation, and the administration of a test dose
to assess tolerance arc then required before the solution is
ready for intravenous infusion. The reticuloendothelial
1088
system quickly clears the microdroplets of emulsion from the
circulation, resulting in a short intravascular half life of only
8-24 hours. Excretion occurs over seven days, mostly through
the lungs. Uptake by the reticuloendothelial system and the
possibility of "immune blockade" has raised concerns about
safety. Intravenous infusion of certain emulsions also seems to
activate complement and stimulate the release of cytokines,
resulting in transient “allergic" reactions .such as hypoten-'
sion, leucopenia, and chest pain.
Fluosol DA20 was the first perfluorocarbon produced
commercially for human use, delivering 5 ml oxygen/100 ml
perfluorocarbon at 100% oxygen,’ and animal studies also
showed that Fluosol DA20 could sustain life at “zero" packed
cell volume. Unfortunately, in surgical patients with acute
severe anaemia (haemoglobin 30-40 g/1) who could not be
given transfusions for religious reasons, Fluosol DA20 was
ineffective in delivering sufficient oxygen to sustain life at the
doses permitted (40 ml/kg).1’ Another use has, however, been
found for it. Fluosol DA20 reduces ischaemic damage to the
myocardium during percutaneous transluminal coronary
angioplasty (presumably because of its small particle size and
low viscosity at low rates of blood flow in small blood
vessels),*’ and is licensed for this indication in the Unitec
States. Although not licensed in Britain, it has been used
successfully on a named patient basis.
SELECTIONS FROM BMJ
vol. 7
February iw:
Alzheimer’s disease, but this should not deter the prospective
researcher or funding agency.
The Eurodem endeavour will be influential not because of
the validation of the size of the effect of a specific risk factor
but because of the care with which the authors have set
out relevant methodological problems. Their reanalyses are.
reported with great caution, yet some issues stand out clearly..
Case definition will remain imprecise and lead to far too many
false negative cases until the present (provisional) clinical
criteria" include pathognomonic objective tests. As gene
environment interaction provides the likeliest pathogenic
model," future epidemiological studies must be supported by
molecular biological investigations.
A recent meeting in Bethesda sponsored by the National
Institute of Aging and the World Health Organisation gave
the authors of the Eurodem report a chance to air their
concerns about future epidemiological studies. Epidemiologi
cal principles can be used successfully to investigate relations
between genetic susceptibility and putative risk factors/'
Simple genetic models can be applied to data where variation
in genetic susceptibility is precisely known (such as the
•presence of a genetic mutation'). Hofman emphasised the
importance of vascular disorders not only as possible models
for Alzheimer’s disease but also as likely causal processes."
Exposure to noxious agents has become a matter of great
public concern that transcends national boundaries. Experi
mental neuropathology provides the vital impetus towards
successful identification of toxins that might contribute to
neurodegenerative disorders," but epidemiology has a major
part to play. Hofman and his colleagues may not have
established that any particular risk factor (other than family
history) is of major importance in Alzheimer’s disease, but
they have certainly set out the directions that future research
might most reasonably follow.
L'J Whalley
Senior Lecturer in Psychiatry,
Royal Edinburgh Hospital,
Edinburgh EH10 9HF
I Deary I J. ^XTallry LJ.
rrwarrh on the
of Alzheimer'i dnetse. BMJ '
I96IJ97 KCJD
?
AS The nU fancn for Alzheimer ’> diteate. a review and ■ hypo them. Acta Pryciiar ’Srzirf J9H.7I 2S7 7S
J GotU A, Chuurr Hu Un MG Mullan M. Brown J, Crawford F. Fidini L, ft al. Sefrefition of a
EJixnv muuuc© in the amyloid prvcuraor protein gene with familial Alxheimer'i diacaac.
Aenrr 3 99J 349 704 6
4 MujtvJ J. Fukm M. Ghent B. Brnaon MD. A mutation tn the axnylotd precursor protein
BLvxuirJ with Ix^rdrtaiy Abhrinwr’i diaeaae Stwuf |99|;2M 979. ’
5 < hintrf ><ar1m M
Crawford I’. Hem Iden H. U’arrvn A. Hughra D, Fid snl L* « al. Early-onaei
Alrheirarr i diwaac tauted by mutations at codon 717 of the P amykud precursor protein gene.
A wv 199J 35) 144-6.
6 Si Gvccjr HyUcv PH, Hrjdci JL. Farrer LA. Polimky R. Van Brocckhovcn C, Goate A, ft al.
Gtottk
rudirs sugjnfl that Alzheimer'a disease is not a single homogeneous disorder.
.Vc.vr 199034T194 7.
* Nrc LE. Lkbidgr R. Sunder land T. Thomas CB. Katz D. Thomson KE. at al Dementia of the
Alihomn type, dimcal and family study of 22 twin pairs. A’rvroL*jy l9t7’J7:J59-6J.
9 Daodhoc EA. Robertson EE Alzheimer • disease with acne rosacea In one of identical twins.
) \nrrJ S'rurrmrf PrydnaD) 1955;!B.72-7.
9 Cxinr DB. Eue-a A. McGerr E. Spencer P, Alzheimer’s disease, Parkinson’s disease and
mcrooruroec disease abxxrophic interaction between aging and environment? Laacrt
19U.il.IC*7.70t
10 Kn DW K. Rrjtfnjtih P. Roth M Old age mental disorders in Newcastle-upon-Tyne. L A study of
prn aimer
J Prytlnairy 1964;] 10:146*51.
11 McKhaxm G. Drachmae D. Fohtan M. Katzman R. Price D. Stadlan E, Clinical diagnosis of
Alxhnmn s disease: a report of the NINCDS ADRDA work group under the auspices of
Drpzrtmmt of Health and Human Semen Task Force on Alzheimer's disease. Nmmbgy
I9MJ4 9)9-44.
12 van Du'.n GM. Hofman A Ridt factors for Alrhetmer’s disease- a collaborative re-analysis of caseccourrf ttud>n f«r) E199J ,20;suppl 2)3-73
31 Omro D 7 be F urtdrra collaborative re-analysis of case-control studies of Alzheimer’s disease;
axoc methodological conuJerations. far J
1991 ;20^suppl 2) 62-4.
34 van Dunn GM. Qmon D. Chandra V, Fratiglkxu L. Graves AB. Heyman A, ft al. Familial
xfprpixr) erf Alzheimer's disease and related disorders: a collaborative re-analysis of caseconuvi studies f»u J
199| ;2O suppl 2>:13-20
IS Ottman R An ep»dem>nlog»c approach to gene environment interaction. Graft Epidranol
IWJ J77-BS.
16 AronK»a MK.Om U L.Mcwgmstrm H, Hafner A.Masur D.Crystal H.rf al, Women, myocardial
irdarHina and drmrntia m inc vrrv old A’nmd.»gy I99U.40 1102-6.
f Sparks DL. Hunsaker JC 3rd. Schefl
Kryscio RJ. Henson JL. Markesbery VCR. Conical
wmle plaqurr in ctmnan anen disease, aging and Alzheimer’s disease.
n frfM-7
1*
ra 1 i.fiMtrTx utrunn audi and nrurupifrchiatnc disorders. Bic4Ptychiatry 1989^2:505-25.
(FROM hMI VOl. MH 16 NOVEMBER 1991. I2H I2IM
Reforming health care in the United States
The American College of Physicians wants universal access to basic health care
At its best American health care may be the best in the world.
Yet an increasing proportion of its citizens would find this is
an empty boast. Between 30 million and 40 million Americans
now lack any health insurance, and another 50 million are
inadequately Covered. Current projections suggest that these
numbers will increase. The American College of Physicians
has therefore identified access as one of the most urgent
problems besetting America’s health care system.
Access to health care decreases as its costs go up, and up is
where they have been going. America will spend about $650
billion on health care this year compared with $75 billion in
1970, an estimated five fold increase when inflation is taken
into account. Spiralling costs have generated ever greater
pressures for cost containment, which have undermined the
basic infrastructure on which the delivery of services
depends —facilities and staff. Efforts by employers, (he
government, and third party payers to control rising costs are
SELECTIONS FROM BMJ
vol 7
February iw:
increasingly intruding on clinical decision making and are
undermining doctor-patient relationships.
Current ways of paying for health care, entailing multiple
public and private insurers and third party payers, arc
complex, confusing, costly, wasteful, and intrusive. Coverage
under both private insurance plans and public programmes
(Medicare and Medicaid) is generally difficult to understand
and requires complex mechanisms for dealing with claims.
Patients’ and their families are burdened with extensive
paperwork.
The need for reform seems undeniable—but where to
begin? Because the problem of access is inextricably linked to
several other substantial problems—such as the cost and
quality of health care, resource allocation, doctors’ dis
satisfaction, burdensome problems for patients, malpractice,
and the limitations of the health insurance industry—the
college believes that only fundamental change will do. To
1091
evaluate various proposals for reform the college drew up a list
of 16 criteria.’ It came down against throwing more money at
the problem —as this could make things worse —and urged
extreme caution over building on the present structure. What
was needed was a thoughtful re-examination of the system of
health care from top to bottom.
So far the college has decided that the solution will be a
nationwide programme, and it wants such a programme
adopted as a policy goal for the nation. The college’s main
focus now is to define further the systemic reforms that are
needed. To make the reform of health care a reality the
college has identified two primary’ objectives: to further an
environment receptive to comprehensive reform and to speak
from a well informed position. On each of the main issues —
containing costs, controlling use, determining benefits,
deciding on mechanisms of financing, and reducing adminis
trative costs —work is continuing deliberately and carefully.
According to the American College of Physicians nothing
short of universal access to basic health care will be fair in the
long run. How that goal is achieved has yet to be determined,
although the college believes that U has identified its principal
elements and proposed some realistic options. These are
currently being reviewed by the members of the college, and
the final proposals should be published next spring. America, •
it believes, can one day develop a system that is fair and
equitable for all.
NORTON J GREENBERGER
President 1990-1
NICHOLAS E DAVIES*
President Elect 1990-1
EUEGENE A HILDRETH
Chairman, Board of Regents 1990-1
American Olkge of PhvMi ians,
USA
Corrrspondcnce to Dr Grvenbcrger, Department of Medicine, University of
Kansas Medical Centre, Kansas City, Kansas 66103, USA)
• Dr Divics died earlier this vear.
2 Azwxu: CziUrpc of Fbt m, icru Actto health ore. /Arr
Med 1990;! 12:641-61.
HROM RMJ VOL 30.1 16 NOVEMBER 1991. I2I6-I2I7*
Does triamterene cause renal calculi?
Aof enough evidence yet to tell patients to stop taking triamterene
Over two million prescriptions for triamterene were issued in
the United Kingdom last year so the possibility that this drug
may cause renal calculi is important. As a potassium sparing
diuretic triamterene is often prescribed in conjunction with a
thiazide and acts on the distal tubule to inhibit reabsorption of
sodium in exchange for potassium and hydrogen ions. Taken
by mouth it is rapidly metabolised to parahydroxytriamterene
and then to parahydroxytriamterene sulphate. Half of the
drug is excreted in the urine, 20% as triamterene and 80% as
metabolite.1
A case report in 1979 suggested the lithogenic properties of
triamterene,’ and this was followed by the observation of an
abnormal urinary sediment in patients and volunteers taking
the drug.1 The sediment, resembling granular casts, was often
deep brown and accompanied by hyaline casts, some of which
were covered with small birefringent crystals; larger round
brown bodies, appearing as Maltese crosses under polarised
light, were also seen. T his abnormal urinary sediment occurs
in about half of all patients treated.* The crystals appear in the
• urine two to four hours after ingestion of the drug, and animal
Andies show that birefringent crystals and casts form within
inc medullary and papillary collecting ducts of the kidney.1
This site of formation is supported by the histological findings
in a patient who developed acute interstitial nephritis after
massive intoxication with triamterene and hydrochloro
thiazide. Tubular plugging by crystal laden tubular cells was
found in renal tissue, although the crystals were not positively
identified as containing triamterene or a metabolite/ Never
theless, only one definite case of interstitial nephritis induced
by triamterene has been reported.7
The presence of triamterene in a calculus may be suspected
by blue fluorescence (440 nm) under long wave ultraviolet
light, but thin layer chromatography* or infrared spectro
scopy provides definitive analysis.' The composition of the
stones varies: half of 66 stones containing triamterene were
found to contain less than 5% and none contained more than
75% of material derived from the drug.’ Triamterene itself,
rather than its more abundant metabolites, was the common
est constituent. Others have also identified stones made
mostly from triamterene* and Carr ci al found that 21% of
1092
stones containing triamterene were made exclusively of it.' In
the remainder triamterene was associated with calcium
oxalate monohydratc and dihydrate, apatite, or uric acid.
But do these data mean that triamterene or its metabolites
cause the stones? Triamterene is not invariably found at the
core of even- stone.’ and Werness ci al showed that triam
terene and metabolites have no effect on calcium oxalate
monohydratc. hydroxyapatite, or uric acid crystal systems,
although they bind strongly to protein matrix.10 In contrast, ’
White and Nancollas showed that triamterene and its
metabolites could induce growth of crystals in supersaturated
solutions of calcium oxalate monohydratc." The clinical
relevance of these in vitro findings is not clear, and, most
importantly, stones in the urinary tracts of patients taking
triamterene do not always contain the drug.12
If crystalluria and casts are common sequelae to ingestion of
triamterene might absorption or excretion be perhaps differ
ent in patients in whom stones form? Carey ci al found no
difference in absorption or excretion of triamterene in such
patients," and this was confirmed by Ettinger, who also found
no difference between patients and controls in total recovery,
hourly excretion patterns, or concentration of triamterene or
parahydroxy triamterene in the urine." The pH of urine does
not seem to affect the solubility of triamterene or its sulphate
metabolite.’ More relevantly, Carey el al point out that those
in whom calculi form early during treatment and with a family
history are more prone to further calculi; this may explain
their observation of a 35% incidence of previous renal calculi
in patients who developed calculi while being treated with
triamterene compared with a 4% incidence of previous calculi
in patients who did not." So perhaps the patient, rather than
the drug, is the risk factor.
A specific lithogenic role for triamterene, and possibly its
metabolites, remains qnproved, although the occurrence of
stones rich in triamterene must tend to support one. The
evidence is not strong enough to warrant patients with a
history of recurrent renal calculi avoiding taking the drug, but
with increasing use further epidemiological information may
become available. Currently in one reference laboratoiv ■
stones containing triamterene arc as common as cystine
SELECTIONS FROM BMJ
. VOL. 7
FEBRUARY I MM.'
VVHO/MNH/PSF/91.3 Rev. 1
English only
Distr: General
PSYCHOSOCIAL CONSEQUENCES
OF DISASTERS
PREVENTION AND MANAGEMENT
ONMMMBMKMMHmaKa
(
<»:
DIVISION OF MENTAL HEALTH
WORLD HEALTH ORGANIZATION
GENEVA
WHO wishes Io acknowledge the valuable inputs into the development of this
document by Professor Bruno Lima, Johns Hopkins, Community Psychiatry Program;
Professor Lars Weisaeth, Psychiatric Institute, University of Oslo; Professor Wolfram Schuffel,
Klinikum der Philipps-Universilat Marburg; Professor Beverley Raphael, Department of
Psychiatry, Royal Brisbane Hospital; as well as of Mr O. Almgren, UNDRO;
Dr T. Yazukawa, Division of Emergency Preparedness and Response, WHO.
I
1
Dr G. de Girolamo, Division of Mental Health, WHO and
Dr John Orley, Senior Med cal Officer, Division of Mental Health, WHO
had the technical responsibility for the production of this document.
Further copies of this document may be obtained from
Division of Mental Health
World Health Organization
1211 Geneva 27
Switzerland
© World Health Organization 1992
This document is not a formal oublicalion of the World Health Organization (WHO),
and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted,
reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors.
Designed by WHO Graphics
CONTENTS
Training and infrastructure for a psychosocial
response in disaster relief
Training programmes for primary health care workers
and other relief workers
Planning and coordination of interventions in case of
disasters
Model 1
Model 2
Model 3
iv
19
19
•
'19
20
20
20
Possible research priorities
22
References and selected reading
23
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
reducing the effects of severely damaging events
on man and his environment once they have has
occurred.
The importance of preventive measures and
preparedness, the integration of an emergency
response within regular WHO programmes,
and the linkage with development have been
emphasized in the resolutions adopted by WHO
in 1981 and 1985. Each of these aspects of coping
with disasters should include consideration of
the related psychosocial components. These can
have an impact on people’s behaviour before,
during and after a disaster occurs, as well as
being important in influencing the overall pat
terns of post-disaster morbidity.
Definition and description of
disasters
Definition
A disaster is a severe disruption, ecological and
psychosocial, which greatly exceeds the coping
capacity of the affected community. This will be
the definition that is used in this document.
However, what constitutes a disaster for one
community might not necessarily do so for
another. The difficulties of conceptualization
anse because, “upwards a disaster is unlimited,
downward one has to draw a line somewhere”.
In common daily usage, the term “disaster”
refers to a great misfortune causing widespread
damage and suffering.
There is, however, no consensus on a scien
tific definition of the term: there are in fact more
than 40 different definitions of disaster in the
literature (Korver, 1987). A disaster is a very
complex, multi-dimensional phenomenon. Am
event may be a disaster along certain dimen
sions, such as ecological, economic, material,
psychological or social, but is unlikely to be one
along all of these in any specific event. Often the
number or human lives lost is an important
criterion for defining a disaster.
The definition may be dependent upon the
event itself, or solely on the consequences of the
event. The term disaster ordinarily emphasizes
fast, destructive change. This may exclude per
manent problems from the disaster definition,
for instance famine in many parts of the world,
even when the consequences of the starvation
are disastrous. To declare an event adisaster may
influence, among other things, the amount of
help offered. The concept also has emotional
and political implications.
2
Much of the confusion in defining a disaster is
caused by the diverse interests of those dealing
with the event, be it in medicine, sociology,
political science or ecology. The definition
adopted usually reflects the role of the organiza
tion using that specific definition.
From a psychosocial perspective, it is impor
tant to consider both the medical disaster defini
tion (an emergency situation in which the vic
tims are so numerous that the treatment needs
far outweigh the resources available at the mo
ment: here there is an immediate need to bring in
extra resources) and the sociological.
Common elements to be considered in the
conceptualization of disasters include:
1. A disaster disrupts the social structure and
cannot be handled bv the usual social mechanisrns. This disruption may create more diffi
culties than the physical consequences
(Quarantelli, 1980).
✓
2. There are several important variables which
can moderate the impact of disasters. These
include, the ability of the victims to adjust
psychologically, the capacity of the commu
nity structures co adapt co die cnsio and die
amount of help available.
3. The concept of disaster changes overtimeand
among different cultures. Among some popu
lations, especially in developing countries, a
lengthy first-hand experience of coping with
natural disasters has produced the creation of
specific “disaster sub-cultures”, which are
likely to affect their pattern of psychosocial
reactions to the disaster situation.
4. Since catastrophic events are frequent in many
developing countries, this may unfortunately
raise the threshold for an event to be consid
ered a disaster. Nevertheless this should not
lead to a failure to recognize and respond to
the adverse effects that may occur, even with
repeated disasters; these may undermine the
morale and resources of the community even
Further, and may lessen its capacity to adjust.
The term “personal disaster” (Raphael, 1985)
has been used to refer to a severe trauma affect
ing a small group or a single individual. This
document however, deals only with those disas
ters affecting large numbers of people.
INTRODUCTION1
Taxonomy
There are many possible ways to classify disas
ters which may have important consequences
with regard to the way people react and the
types of help required.
From the prevention and preparedness view
point, the following classification is generally
used:
Natural disasters — Earthquake, flood, cyclone,
hurricane, tornado, landslides, volcanic erup
tion, drought.
Man-made disasters — Technological disasters
such as toxic, chemical and nuclear accidents,
dam collapse or transport accidents.
Man-made disasters are caused by human
failures or accidents, or are due to violence or
war. The feeling that someone is to blame may
make it more difficult for victims to cope with
the situation. However, a clear distinction be
tween what is man-made and what is natural is
sometimes impossible, because of the increasing
effects of man’s actions on the overall ecological
balance or other human contributions.
For instance in an earrhauake. the noor construction of buildings can contribute signifi
cantly to damage and loss of life. The failure of
1'4
authorities to provide adequate warning of a
“ natural” danger can contribute to the loss of life
and damage. Any rise in the level of the oceans
due to pollution causing a “greenhouse” effect,
may increase the likelihood of floods. Famine or
social conflicts may strike certain parts of coun
tries, nor just because of drought and crop fail
ure but also because of transport problems,
hindering the movement of food. Bush fires may
or may not be started by man. These examples
are just a few amongst many possible ones that
demonstrate the blurring that can exist between
natural and man-made disasters.
The speed of occurrence is another important
graphic community. In one which happens to a
group of people who have come together by
chance (e.g.an airplane crash), survivors return
to their respective ►geographic communities
where the physical setting and social support
networks are still intact. Such disasters could be
considered geographically penphcral. An inter
mediate type, according to this dimension, would
be one which occurs to a group of people within
a community and, hence, affects the whole com
munity in some sense, but where there still
unaffected members of the community
and the
z
physical settings (homes, neighbourhoods) re
main unchanged.
The most central type of disaster would be
one in which the whole physical and organiza
tional structure of the community is deeply
changed (e.g.earthquake, floods, etc.), because
homes are destroyed, people arc relocated in
different surroundings with strangers, etc. In
this central type the traumatic aspects are not
limited to the impact of the physical event itself,
but may continue for a relatively long period of
time and include many subsequent additional
traumas, changes, and disruptions especially of
a psychosocial kind, requiring further adjust
ments.
Transnational character of many disasters
Many
disasters are transnational or international
*
in their effects and impact. For instance nuclear
or toxic accidents may have effects on many
countries across frontiers and at considerable
distances from the place where the event oc
curred. The nature of frontiers (legal, official,
political) cannot prevent this, and there are many
implications fordisaster response. Similarprob
lems may arise m international transport acci
dents such as air crashes.
An adequate response to such transnational
disasters has to be set up at the same transnational
level. This means that international coordina
dimension to be considered in assessing disas
ters and their consequences on the affected popu
tion by a specialized health agency such as WHO
lation. Perhaps the most well known typology
of disasters however, is that of Barton (1969). He
and intervention programmes, in order to en
is undoubtedly needed in terms of preparedness
sure consistent and uncontradictorv responses
in rhe various countries affected. Moreover
suggested four main dimensions: scope of im
pact (geographical, number of people); speed of
WHO is in a special position to ensure a com
onset (sudden, gradual, chronic); duration of
mon scientific international lansria^e amons: the
impact (e.g.repeated episodes); and social pre
various researchers and clinicians active in the
paredness of the community.
medical and psychological field. The adoption at
A further important dimension has been added
an international level of chc 10th Edition of the
(Green, 1982) which refers to whether disaster?
ICD is an important step in this direction (WHO.
arc central or peripheral with respect to a geo
1990).
3
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
Epidemiology of disasters and
morbidity profiles of the affected
populations
Estimates of the major disasters which occurred
worldwide (excluding the United States) from
1900 up to 1988, indicate that, in these 9 decades,
about 339 nullion people have been affected by
floods, with a total of 36 million rendered home
less; 26 million have been affected by earth
quakes, with similar numbers affected by ty
phoons anticyclones, creating another almost
10 milircSg^meless people; finally, 3.5 million
have been'affected by hurricanes, resulting in 1.2
million people without homes. From 1970 to
1981, floods were the most frequent disaster,
comprising more than one-third of all disasters
occurring in that decade. Windstorms were the
next most frequent disaster (one fourth of the
total number), while earthquakes caused the
greatest number of deaths and monetary loss.
The actual numbers killed in disasters is esti
mated to be some 3"or4 times higher in develop
ingcountries than in the developed. The striking
difference however is in the number of survivors
who are affected, which is estimated to be some
40 times higher in the developing countries. One
must presume that this indicates a massive
psychosocial as well as physical need for this
latter group.
The geographical distribution or disasters
between developed and developing countries
deserves attention, as there seems to be a rela
tionship between the location of a disaster on the
one hand, and the severity of its consequences
on the other. Out of the 109 worst natural
disasters which occurred between 1960 and 1987,
as selected and studied by Berz (1989), 41 oc
curred in developing countries; however, the
number of deaths caused among the affected
populations was far greater in the developing
countries (758 850 deaths in developing coun
tries as compared to only 11 441 in developed
countries).
In general the number of deaths and injuries
and the amount of damage is closely related to
the prevailing level of economic development.
An UNDRO publication (1984) shows a list of
disasters for the period 1960-81 resulting in the
greatest numbers of people killed. All occurred
in countries characterized by a low-income
economy: Bangladesh (633 000 deaths), China
(247 000 deaths), Nicaragua (106 000 deaths)
and Ethiopia (103 000 deaths).
The extent of risk among many populations,
especially in developing countries, has increased
over the last fewdecades due to increasingpopulation size, greater population density in vulner
able areas and the strong tendency of large popu
lations towards urbanization. There has also
been a concurrent increase in the magnitude of
certain types of man-made disaster. Very little
however is known about the stress-related dis
orders caused by such events, which represent
an important area in need of investigation.
Indisastersituarions certain vulnerable groups
tend to exist. High mortality may be seen among
elderly people and young children. Children up
to 2 years old may show lower mortality than
their elder brothers or sisters, perhaps because
parents protect their youngest children but can
not afford to help older ones. Pregnant or lactat
ing women and persons already suffering from
existing disease are also more vulnerable, as are
the poor or certain minority groups who might
for instance, have no choice but to live in floodprone areas.
The morbidity: mortality ratio, as well as its
relation to property destruction, is specific to
each type of disaster. For example, in big earth
quakes the ratio of morbidity: mortality is usu
ally 3:1. Floods show high mortality rates but
few injuries. Hurricanes cause fewer injuries
and deaths, but great loss of property.
EPIDEMIOLOGY AND DESCRIPTION OF
PSYCHOSOCIAL REACTIONS TO DISASTER
Historical perspective
Tli^irsF^^tematic studies of the psychological^
ant^s^hiatricconsequences of a disaster were.;
undertaken by Eduard Stierlin (1909) from
Zurich who investigated 21 survivors of a min
ing disaster in 1906 and 135 persons two months
after the earthquake in Messina in Italy in 1908.
The history of traumatic neurosis in European
medicine is well described by Fisher-Hornberger
(1975) who demonstrated that the understand
ing of the disorder during the 19th and early
20th century was very much influenced by po
litical, military, economic and cultural factors,
with an over-emphasis on an organic basis for
traumatic neurosis. However, during World War
I the psychological nature of the disorder was
betrer understood.
During; World War II, the study or how
civilian populations reacted to disaster traumas
was further advanced. The air raids against cities
was the background for a series of valuable
investigations earned out in England during the
early war years. A striking rinding was that the
expectations of “mass neuroses” in a bombed
civilian population did not occur. Unfortunately
the war time psychiatric experiences have not
been fully incorporated into the disaster litera
ture, although psychosocial interventions in di
sasters have been influenced by insights gained
injury, danger traumas and- loss-Traumas
(Lindemann, 1944). Until the 1970s<ho,wcver, ,
the’psychosocial disaster literature was .periodic '
anduninregrated. Since the 1970s a rich literacure, largely American and Australian, has been
published. There is also important work in other
languages (German, Russian, Spanish and
French). As a research field, however, the study
of thepsychosocial consequences of disasters is
still relatively untouched.
Emotional reactions may be divided into the
immediate experience during the disaster and
those reactions occurring after the event, some
o£ v/HicH mciv
soon cind otHcrs
The immediate experience
The immediate reactions reflect the most horri
fying dimensions of disaster related to severe
club fire disaster in Boston in November 1942,
which claimed the lives of 491 persons. This
scrapers, disasters can evoke panic more easily.
disaster has come to occupy a special position in
disaster psychiatry because it represents one of
Health education programmes and previous
training in simulated disaster situations can help
the first systematic civilian studies on the acute
psychological reactions in victims of physical
affected populations to avoid panic and respond
former. The military psychiatric experiences
from World War II influenced civilian clinical
practice with the introduction of the therapeutic
community, group treatment, forward psychi
atric treatment and crisis intervention.
Of special note is the Coconut Grove night
j
Phases of emotional reactions to
disasters
physical injury, exposure to extreme danger,
witnessing death of close ones or mass deaths
and injuries, traumatic experiences of helpless
ness, hopelessness, separations, and the need to
choose between helping others or fighting for
one’s own survival. Maladaptive reactions dur
ing exposure to a disaster such as paralyzing
anxiety, uncontrolled flight behaviour and group
panic, may be incompatible with survival. In
studies of disaster behaviour the individual’s
level of preparedness, disaster training and edu
cation have appeared as the most important
determinants or a good outcome (Weisaeth,
1989). (Being able to cope in the immediate
trauma situation also came out as a strong pro
tector in terms of longer term psychiatric
sequelae).
Panic is said to be rare in natural disasters, but
in crowded areas like subways, trains and sky
during war, lately the Vietnam war. Among
wartime psychiatric cases both stable as well as
vulnerable personalities were found, but the
latter did not recover within weeks as did the
;
more appropriately.
5
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
Emotional reactions after the "event"
Many different emotional reactions may occur
after a disaster. In the beginning many people
feel numb., or even elated and relieved, often
with strong positive feelings about having sur
vived. Gradually however, the stress effects may
show, although these reactions are usually rela
tively short-lived and may be considered a nor
mal reaction to a traumatic experience.
Common post-disaster reactions include in
tense feeling of anxiety, which may be accompa
nied by “flashbacks” or intrusions and frighten
ing memories of the experience. There may be
nightmares, waking the person with panic. Any
reminder may trigger these feelings, and the
person may try to avoid all such reminders or to
shut out feelings (avoidance response). Anxiety
and intrusive memories or reexperiencing, espe
cially of life threatening or gruesome encounters
with death, may alternate with numbness and
avoidance. The affected person may also be
highly aroused, as he or she is fearful and trying
to protect himself or herself from a return of the
frightening experience. Normally all these reac
tions settle over the first weeks. If however,
these reactions are maintained at a hie;h level and
for more than a few weeks, they represent a
post-traumatic stress disorder (PTSD). Occa
sionally the symptoms may not appear for sev
eral months or more. Spontaneous recovery
occurs m the majority of cases but m a small
proportion the conditions can last many years.
In silent toxic or nuclear disasters, when no
impressive destructive event occurs, the external
danger may be invisible and people are likely to
focus on their physical health. Uncertainty and
insecurity may create anxiety and fear reactions
and their accompanying somatic symptoms may
induce a false perception of being physically ill,
resulting in pressure on somatic health services.
among people with a preexisting vulnerability.
The latter view can be found especially in some
of the sociological literature, mainly from the
US. There may be certain reasons why this view
has been put forward: (a) some of the disasters
cited involved little loss of life and mainly in
volve material damage, (b) poor detection meth
ods were used to find psychological distur
bance.
There may be a tendency in some cases to
dismiss certain severe psychological reactions to
disaster as only “natural”. It should be noted
however that severe bruising and fractures may
be quite “natural” reactions to a fall from a
height, but this does not diminish the intensity
of the suffering or obviate the need to help those
affected.
Up to a few years ago, little was known about
the psychiatric epidemiology of disasters in de
veloping countries. In fact with the exception of
some recent work in the United States and Aus
tralia, very little is known of the true incidence
of psychological traumas and related distur
bances following disasters even in developed
countries. Previous research was based on un
systematic clinical observations or crude indica
tors of psychiatric morbidity such as aamissions
to psychiatric hospitals (e.g. Ahearn, 1981). Only
following disasters in recent years in Colombia
1985, Mexico 1985 and Puerto Rico 1985, have
systematic studies been earned out. They sug
gest that victims present marked and prolonged
psychosocial problems whose prevalence is sig
nificant. Because of the often devastating physi
cal impact which natural disasters have on popu
lations living in developing countries and be
cause of the scarcity of resources there, inter
ventions have generally been confined to rescue
and to the provision of basic medical care, with
a corresponding neglect of psychological needs
and related epidemiological research and inter
vention. Furthermore, the existence of some
Spidemioiogy of psychological
disorders following a disaster
disasters, especially in developing countries,
As stated by Perry and Lindell (1978) and by
makes it difficult to apply findings from re
UNDRO (1984), different views have been ex
pressed by various authors about the extent of
search carried out among populations only ex
ceptionally affected by a disaster”. The different
culture patterns, social structures, and coping
behaviours may reasonably modify the inci
dence, the seventy, and the psychosocial out
come, pointing to a need for specific research on
psychological disorders following a disaster.
Some hold the position that disasters represent
catastrophic events producing adverse psycho
logical reactions among most victims, while oth
ers suggest that the extent of the problem has
been overestimated, and thatpsychological prob
lems due to the stressful event(s) appear only
6
clear “disaster sub-cultures” among populations
with lengthy experience in coping with natural
these populations.
The specific behavioural pattern, character
ized by a stunned, dazed, and apparently disen
EPIDEMIOLOGY AND DESCRIPTION OF PSYCHOSOCIAL REACTIONS TO DISASTER
gaged behaviour, called “disaster syndrome”,
has been described as a response to impact and
immediate aftermath. It is said to occur in about
25% of chose affected by disaster (Frederick,
1981; Raphael, 1986). On the other hand Duffy
(1988) has stated that a “disaster syndrome”,
represented by the immediate post-disaster re
action, is present in up to 75% of victims during
the first hours or days after the event. Anxiety or
anxiety-related reactions are extremely com
mon. They may continue from the high arousal
that comes with impact or, more often, emerge
after a latent period of a few hours or days. In
different studies which employed a psychiatric
screening schedule to assess the psychological
status of the victims of the disaster, the percent
age reacting over the first weeks as shown by the
questionnaire score seems to vary from 70% or
more to 20%, in large part correlating with rhe
severity of the experience. Levels may remain
high in the early weeks. Then, by 10 weeks, there
is usually a significant drop with a gradual de
crease continuing over the first year (Raphael,
1986).
Disturbances may carry over from the imme
diate disaster experience impact phase to the
immediate oost-disaster phase: for example in
some industrial disasters studied, about 15% of
the affected populations displayed rhe
derealization/aparhv symptoms of rhe disaster
syndrome with absence of emotions, lack of
response, inhibition of outward activity with
stunned, shocked and dazed appearances. Dis
organized
flight
o
o behaviour is common, whereas
brief psvchotic reactions occur only in a small
minority. The physical symptoms of anxiety
and stress are more frequent. These symptoms
are important in that they hamper the person’s
ability to carry out planned actions, and may
become rhe starting point of a somatization
process (which can be misinterpreted as physi
cal injury, illness, toxic poisoning etc.).
According to Raphael (1986), psychological
morbidity tends to affect some 30-40% or the
disaster population within the first year follow
ing it. At two years, levels are generally less bur
with a persistent level of morbidity that seems to
become chronic for some individuals and ror
some disasters. Disasters that are man-made and
with high shock and destruction show persist
ing levels of over 30% severe impairment. Con
trasting findings from different studies can be
o
•
1■
explained in terms of differences m sampling
methods, methodologies, diagnostic categories,
and types of disasters under study, as well as
differences in interpretations of the same data.
More specific evaluations of morbidity patterns
have examined mortality, psychosomatic illness,
mental health problems, physical sympto
matology, consultation-based health care utili
zation, hospital admission and alcohol and drug
usage. Mental health problems, as defined by a
range of different measures, are shown as in
creased in systematic studies. The diagnostic
inconsistencies among different studies and dif
ferent research groups are especially important.
The ICD-10 (WHO, 1990) provides a useful
conceptual framework for clinicians and re
searchers active in this field, recognizing three
mam diagnostic categories of disorders caused
by exceptionally stressful life events producing
an acute stress reaction, or by a significant life
change leading to continued unpleasant circum
stances which result in an adjustment disorder.
The three main diagnostic categories are: (i)
acute stress reaction (F43.0); (li) post-traumatic
stress disorder(F43.1); (iii) adjustment disorder
(F43.2). In addition the ICD-10 recognizes en
during personality change after a catastrophic
experience (F.62.0).
A recent thorough review has analyzed the
relationship between disasters and subsequent
psychopathology for 52 studies which used quan
titative measures (Rubonis & Bickman, 1991).
The authors examined relationships among four
sets of variables: (a) the characteristics of the
victim population, (b) the characteristics of the
disaster, (c) the study methodology and (d) the
type of psychopathology. In the studies exam
ined, between 7 and 40% of all subjects showed
some form of psychopathology. The type of
psychopathology with the highest prevalence
rate was general anxiety (almost 40% of the
studied subjects), although its variability is also
among the highest. Phobic symptoms (32%),
psychosomatic symptoms (36%) and alcohol
abuse (36%) appeared to show slightly lower
levels of prevalence, with depression (26%) and
drug abuse (23%) somewhat lower still. Using
meta-analytic techniques, the authors showed
that in these studies a positive relationship
emerged between disaster occurrence and psy
chopathology, indicating an increase of approxi
mately 17% in the prevalence rate of psychopa
thology (compared with a predisaster or control
group rate) as a result of a disaster. The number
of female victims in the samples studied, the
death rates, and the amount of time that had
elapsed since the disaster event were all directly
related to the amount of psychopathology.
7
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
Finally, higher impairment estimates were Found
for naturally caused disasters (c.g.volcamc erup
tions) as opposed to those caused, at least in part,
by humans (e.g.nuclear accidents). This latter
finding however contradicts much o the litera
ture published so far.
The severity of the stressor (f _>r example
threat or loss) has been strongly cc rrelated in
all studies, with the severity of the pathology
or reaction engendered, although c ther vulnerability factors are also important. The main
clearly defined syndromes that appear follow
ing disasters are the PTSD, the survivor syn
drome and the disaster bereavement svndrome.
As regards the first, social withdrawal contrib
utes most to impairment. An interesting finding
from some studies is that irritability, anger and
aggression increased over the four-year follow
up. Irritability is in fact, a very common reac
tion, and is perhaps especially so with uman
made” disasters in which a human agency can be
blamed. Bereavement disorders, when chronic,
are notoriously resistant to treatment.
Not only psychological disorders but also
physical disorders and mortality rates have been
shown to be higher in survivors of disaster. In
tHs rzts of coronQrv hs2rt disease
morbidity and mortality is increased. This has
been shown in a study of earthquake survivors
(Katsayannietal., 1986).Srud: .*s have also shown
V.
that this increase in physical disease is particu
larly marked in the year alter! le disaster amongst
the relatives of people who o4ed at that time. It is
presumed that this increase in disease is caused
by psychological factors.
Relationship between type of
disaster and the type and severity
of reactions
The severity or psychosocial reactions to adisaster will depend on many factors in the individual
and the commuruty. Where there is great loss of
life there is likely to be much grief and perhaps
disruption of family and community life. Loss
of homes and property may destroy the sense of
the community and create stress in association
with the hardships. Where support is available
*
and some meaning can be made of what has
happened, and especially when there are op- •
likely to be adverse. Similarly when there is little
support or people feel helpless and unable to
take charge of their own recovery, this also has
a negative effect orrthe outcome.
Specific psychosocial
consequences following disaster
Post-traumatic stress disorder
The most severe psychiatric disorder conse
quent upon disaster is represented by posttraumatic stress disorder. This arises as a de
layed and/or protracted response to a natural or
man-made disaster of an exceptionally threaten
ing or catastrophic nature, which is likely to
cause pervasive distress in almost anyone,
As stated in the clinical descriptions and diag
nostic guidelines accompanying ICD-10, typi
cal PTSD symptoms include episodes of re
peated reliving of the trauma in intrusive memo
ries (“ flashbacks ”) or dreams, occurring against
the persisting background of a sense of “numb
ness” and emotional blunting, detachment from
other people, unresponsiveness to surround
ings, anhedonia, and avoidance of activities and
cimonnnc rprmnicrpnrnf
rrsnrriq Commnrilv
there is fear and avoidance of cues that remind
the sufferer of the original trauma. Rarely, there
may be dramatic, acute bursts of fear, panic or
aggression, triggered by stimuli arousing a sud
den recollection and/or re-enactment of the
trauma or of the original reaction to it.
There is usually a state or autonomic
hyperarousal with hypervigilance, and enhanced
startle reaction, and insomnia. Anxiety and de
pression are commonly associated with the above
symptoms and signs, and suicidal ideation is not
infrequent. Excessive use of alcohol .or drugs
may be a complicating factor.
Some people may respond to trauma with
symptoms which last only briefly or with milder
symptoms which hardly justify a diagnosis of
“disorder”. Some workers in the field have re
ferred to these as “post-traumatic stress reac
tions”.
The onset follows the trauma with a latency
period which may range from a few weeks or
J
months (but rarely exceeds 6 months). The course
is fluctuating but recovery can be expected in the
majority of cases.
portunities for individuals and the community
to be actually involved in their own recovery,
the outcome is likely to be better. Where there is
obvious blame, human negligence, malevolence
or violence, and little support, the outcome is
'
8
'J
*
Grief
For those people who have experienced signifi
cant loss, the emotional reactions which occur
EPIDEMIOLOGY AND DESCRIPTION OF PSYCHOSOCIAL REACTIONS TO DISASTER
after the disaster are likely to be those of grief.
There may be grief for the loss of loved ones, or
fabric and the breakdown of traditional forms of
social support. “Temporary camps” providing
inadequate facilities, are known to house victims.
for years. Disruption of families can also have
home, treasured possessions; livelihood orcommuniry. The seventy of the morbidity is greater
for the individual when associated with personal . important psychosocial consequences upon the
loss due to death of a loved family member. The
members and particularly on small children with
Emotional reactions of grief include sadness,
no accompanying adults.
distress, anger, and' longing and yearning for .
Unnecessary hasty procedures for: dealing
.with dead bodies, under the guise of preventing
. what has been lost. The bereaved person may be
preoccupied and miserable. Usually grief reac
outbreaks of communicable diseases, can lead to
such rapid burials that proper identification may
tions diminish
to some
extent by
•
•
• 4-6 weeks,
•
•
although stresses' may complicate or prolong
not be;possible and full mourning procedures
' them and anniversaries mav induce recurrences.
may not occur. Likewise, overenthusiastic vac
A number of studies have pointed out a number
cination programmes may be initiated for the
of factors that might increase psychological . same reason. Other misbeliefs mav lead to unnecessary extra stress on victims of disasters.
morbidity among the bereaved: lack or weak
ness of social supports, female gender, loss of a
child. There are circumstances of violence and
Vulnerability
the dead body
has
been
unable
to
be
found
or
*
When disaster is nor followed bv new and addiviewed bv the bereaved. For some of those who
tional stressors, early prediction based on an
have suffered losses, grief may become chronic
and the emotional reaction mav intensify into . evaluation of risk factors (risk situations, risk
individuals and nsk reactions) may be possible,
severe depression.'
,
thus allowing the health workers to concentrate
their interventions on high risk cases.
Alcohol, drug abuse and family problems
An immediate adverse psychological response
rg rrnurrm
n
ctor of PTSD. Thu*
and drug consumption following a disaster, while
social withdrawal, particularly in association
with numbing, can be the most frequent form of
morbidity in interpersonal relationships. The
prolonged stress of the aftermath, the preoccu
pation with painful memories or losses, or the
disruption of home, family and community life
and even work, mav all adversely affect adjust
ment. Family conflicts and problems may occur.
Children may be overprotected and sometimes
familv
violence mav
result. For most families
J
4
and individuals these problems are short lived
and transitional, but for some they are delayed
or become chronic. Others may respond to the
challenge of the disaster and appear to show
greater strength and coping, so that rather than
social pathology or community breakdown,
there may be enhanced social and community
functioning.
Secondary psychosocial stressors
screening instruments measuringthe mental state
shortly
after a disaster can be used to identify
J
nsk cases. By combining this with individual
nsk factors (such as previous psychiatric im
pairment) and the intensity of disaster stress
exposure, high predictive power has been
achieved.
The results from longitudinal studies can be
summanzed as follows: after exposure to a bnef
disaster trauma, a person without marked
premorbid vulnerabilities may expenence the
symptoms of a post-traumatic stress reaction
but should be expected to gradually overcome
and finally to recover completely’ from these
symptoms, provided that the conditions are made
favourable for rehabilitation, that qualified treat
ment is offered when needed and that the person
is motivated to work with his problems. The
majority of survivors who develop long-stand
ing PTSD have been found to suffer from some
kind of pre-morbid vulnerability.
Certain specific stresses can arise in the wake of
disasters,consequcntuponsocialchanges.These
include the displacement oi individuals to other
geographical areas, housing people in camps,
unemployment, inactivity and lack of recre
ational possibilities, the fostering of dependency
in survivors, general disruption oi the social
Stress upon rescuers
There are two categories of rescuer: the nonprofessional and the professional. The stress
upon the non-proressional rescuers mav re
semble that on the victims, inasmuch as they
A
may be caught up m the impact of the disaster.
9
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
As volunteers or bystanders in the interim pe
riod before professional help arrives, they may
suffer the tenable trauma of not being able to
achieve success in their rescue attempt. Also for
the professional, failure to be able to rescue
victims, especially children, is a significant stres
sor, comparable only to the loss of a colleague.
Even a professional rescuer, such as a fireman,
may be overwhelmed by the magnitude of a big
disaster as compared to an individual catastro
phe. The available resources usually seem too
small, creating feelings of powerlessness and of
being terribly alone. As always, stress is better
endured when experienced as an active partici
pant rather than as a passive victim. In disasters
affecting people one knows personally, such as
in company and community disasters, rescuers
especially need to adopt a very “professional
attitude .
Exposure to death and dead bodies has been
repeatedly identified as a major stressor follow
ing all such events. Children's bodies represent
the most stressful types of exposures (Ursano,
1987). The psychosocial consequences on both
survivors and rescuers of a large number of dead
•___
I
n
bodies also presents needs to be taken account
or, and is probably best dealt with by having
certain rormal procedures laid down on how to
deal with this situation. It is very unlikelv that
those who have died will have been suffering
from infectious diseases. Some of the enforced
“hygienic” measures seem to reflect people’s
fear of dead bodies, more than any actual health
danger, and may lead to considerable psycho
logical
distress in the survivors.
o
It follows from the definition (exceeding the
coping capacity) that in the initial phase of a
disaster not only
•f the victims but also the rcscuers/health personnel are faced with a demanding
situation where not everyone can be helped
optimally. This is the essential difference be
tween emergency medicine and disaster medicine. Although the practice of emergency medi
cine is the basis for disaster medicine, the latter
calls for a much simpler and less resource de
manding practice. Helpers may find it difficult
•J
y
It has been pointed out (Yule and Williams,
1990) that several of the early studies of children’s
response to disaster trauma suffered from meth
odological limitations. For instance several of
the scales frequently used to assess the psycho
logical consequences of disaster were never in
tended to measure the effects of trauma on chil
dren, or have a poor validity for this purpose.
There is now a consensus that teachers report
less psychopathology among child survivors
than parents do, and that both teachers and
parents report far less than the children them
selves. In this type of research screening instru
ments used on their own, without detailed inter
views with the child, are of limited value. In
combination, however, they reveal a consider
able amount of post-disaster stress reactions
among affected children (Pynoos et al., 1987).
Regressive behaviours with clinging to parents
and heightened dependency arc frequent find
ings.
The early studies showed that in the majority
or cases the disturbances are shortlived (Garmezy
and Rutter, 1985), but only a few studies have
investigated the effector majordisasters in which
the children had been exposed to life threatening
factors. In the aftermath of the Buffalo Creek
disaster, Newman (1976) found, among chil
dren under 12 vears of age, an enhanced vulnerability to future stress, and an altered sense of
power over the self. The effects upon the chil
dren seemed to depend upon their developmen
tal level at the time of the trauma, their percep
tions of family reactions to the catastrophic
event and the degree of direct exposure of the
children themselves to the trauma. It should be
noted that studies (Bloch et al., 1956) have round
that children tend to reflect their parents’ reac
tions.
As in many adult survivors of acute trauma
suffering from PTSD (Weisaeth, 1989b), psy
chic numbing has also been difficult to detect in
children and adolescents, and often takes the
people that need help without any help because
of insufficient resources. It is important for the
form of withdrawal into uncustomary
behavioural patterns (Frederick, 1985). The sense
of foreshortened future, which is a symptom of
PTSD, resulting from the exposure to mass deaths
may have particularly severe effects in children,
disaster workers to be well aware of the lowest
level of interventions that is still acceptable and
causing them to give up their involvement in
education, expectation of having their own tami-
to be trained to tolerate feelings of insufficiency,
lies in the future, etc.
to change their way of working. In particular,
they may find it difficult to have to leave some
powerlessness and helplessness.
10
The psychological effects of disasters
on children
PSYCHOSOCIAL INTERVENTIONS
IN DISASTERS
Prevention and treatment of
psychological disorders
From the psychological point of view, the pri
mary prevention of disasters must deal with
denial as a common psychological reaction to be
found among populations exposed to a threat.
The negation of an imminent threat can make
forewarning useless, and expose populations to
avoidable risks by producing a delay in adopting
preparedness measures. Therefore health work
ers may have an important role in reinforcing
warnings and thus making timely and effective
prevention possible.
Psychosocial prevention can also play an es
sential part in preventing and minimizing the
psychological consequences of disasters, espe
cially rhe occurrence of PTSD. In terms or inter
vention programmes aimed at preventing and
treating psychological disaster-related disorders,
the main needs following; natural disasters exist
in developing countries and among socioeco
nomically deprived individuals. Since in devel
oping countries the resources devoted to mental
health are often inadequate to meet even routine
needs, the primary health care system is the first
and often the onlv health network available in
the case of a disaster. It should not be forgotten'
however that the population affected by a disas
ter might well retain considerable coping ca
pacities. They should not be treated as com
pletely helpless, and assistance should be di
rected at mobilizing local strengths wherever
possible. Moreover, for socioeconomically de
prived individuals, primary care is the only mean
of extending health and mental health services.
In addition, in manv
• disasters, besides a certain
number of people who have been severely af
fected bv it, there will be a much larger number
of less affected people who will however, dis
play a variety of functional complaints and psy
chological disorders. Functional complaints and
psychological distress in somatic terms
(Goldberg & Bridges, 1988). In order to cope
with general anxiety and also uncertainty about
the possible health effects of the disaster, people
focus on the more tangible aspects oftheirphysical state of health, seeking out the health care
system and requesting explanations. Especially'
in the absence of reliable data about the health
effects of the accident (for example in the case of
toxic, chemical and nuclear disasters), medical
workers lack adequate explanations and may
well respond with extensive and intensive diag
nostic screening of populations and individual
patients. The paradox in the situation, however,
is that attempts to reduce such illness behaviour
and such extensions of the diagnostic proce
dures, in order to diminish the probably un
founded attribution of symptoms to the disas
ter, would deprive people of a coping strategy' if
no alternative were made available. For all these
reasons, the primary’ health care worker repre
sents the crucial locus for the intervention. The
proper handling of the psychological problems
associated with a disaster is of great importance
and must be included in the training programme
of all health workers potentially involved in the
care of affected people. The training of primary
health care workers to give appropriate treat
ment to people attending health centres and
showing emotional distress due to a verv stressful event, deserves priority' (Lima, 1986); such
training represents one of the main prepared
ness activities.
There are other considerations which under
score the importance or integrating mental health
services within the framework of the existing
health system, and especially the primary care
system:
1. Many potential users do not come to a facility'
which is openly' labelled as a mental health
somatization disorders will be particularly com
mon among people attending primary health
care and medical facilities, as the majorin' of
service, since chev do not see themselves as
people needing specialized help but consider
themselves onlv as victims of extreme adver-
people in developing countries tend to express
si tv.
” PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
2. It is well known that the large majority of
cases of psychological distress among
attenders of health centres go unrecognized,
do not receive proper care and represent an
important burden for the health services. Bet
ter and prompt recognition and management
of these disorders, including PTSD, can im
prove their outcome and reduce the burden
on the health services.
3. The primary health care network, thanks to
its central position in the community, can
guarantee proper follow-up of victims and
their families for as long as they need.
Teaching preventive psychiatry
This will involve educating and training the
entire spectrum of professions concerned with
disaster rescue operations in the basics of disas
ter psychiatry, such as emotional first aid. The
target groups are not only the medical, para
medical personnel and ancillary staff (such as
switchboard operators, who have a vital role to
play) found in a hospital, but also personnel in
the associated organizations such as the police,
fire brigade, civil defence, the clergy, industrial
safety personnel, and administrators with spe
cial responsibility for disaster planning etc.
Leadership
In this framework, the role of the specialized
mental health team should essentially be one of
supervision and training, and only especially
difficult cases should be referred fordirect treat
ment.
Two recent papers have reviewed the empiri
cal evidence for the effectiveness of a range of
treatments for 'post-traumatic stress disorder
(Davidson, 1992; Solomon er al., 1992). With
regard to drug treatment, amitriptyline and
imipramine are both effective, and will help with
disturbed sleep. Doses up to 200-300 mg/day
may be required, although attention should be
given to possible side effects. Treatment should
be continued for at least 8 weeks. Other studies
have examined the efficacy of behavioural tech
niques, consisting of different forms of system
atic desensitizarion orflooding; these techniques
have been found helpful, especially in terms of
reducing PTSD intrusive symptoms. Cognitive,
psychodynamic and hypnotic techniques also
hold promise. Clinical experience tends to sug
gest that brief short term counselling may be
helpful in the early stages of the disorder, before
it becomes entrenched. This is particularly so if
the person is able to deal with the effects of
helplessness and fear that surround everybody
after a disaster, through catharsis, support and
cognitive restructuring of the experience. Fur
ther research however, is needed before any firm
conclusion can be drawn as to the comparative
effectiveness of different treatment methods.
Function of the mental health
professional expert in
preparedness activities
The mental health professional(s) at the national
or subnational (e.g.provincial) level should be
responsible ron
12
The senior professional should organize and
lead the specialized disaster psychiatric teams
made up of other mental health professionals as
well as others that are activated during the acute
phase of an actual disaster (loss support group,
liaison psychiatric team, stress management/
debriefing teams, as set out below).
Mental health care during the first 6 months
The first 6 months after a disaster may require
general counselling for those who present to
primary rare with recognition and referral of
those with special mental health problems such
as PTSD, depression and grief. Early treatment
may help to prevent problems.
Planning long-term follow-up of victim groups
The second 6 months or so after a disaster, that
is between the acute phase and the longer term,
is an important rime, as much of the psychologi
cal work is done then.
During
O this stage,
O' one should be aware that
“anniversary” reactions tend to crop up; certain
days may serve as reminders of what rhe victims
have been through. There may also be a need to
follow-up avoidance behaviour, because this
may indicate a delayed onset of symptoms in
victims who have not displayed the full posttraumatic stress syndrome.
Mobilizing support at different levels
This includes the ogiving
o of advice to victims and
helpers about coping techniques and the mobi
lization of support irom family, friends, work
mates and neighbours.
A clearing
o
o house for
information on available resources should be set
up.
It may be useful to have some model pam
phlets presenting essential information that can
PSYCHOSOCIAL INTERVENTIONS IN DISASTERS-
be rapidly adapted to a particular disaster situa
tion and distributed to relevant-groups, such as
survivors, bereaved families, rescuers etc.
In massive disasters particularly in third world
countries, killing tens of thousands of people,
the only active element of the psychosocial or
ganization that is possible in the turmoil of the
acute post-disaster phase may be that at the
senior staff level, trying to influence decisions
and providing psychological support.
Functions of the mentai health
team at the disaster site
While the considerations described so far apply
both to developed and developing countries, the
following proposals, focusing on the functions
of the specialized mental health team, are appli
cable especially in the developed countries. Only
these countries can usually afford the heavy
burden of setting up and maintaining a specialist
mental health service which can be mobilized at
times of disasters. Nevertheless, it is hoped that
the following guidelines can provide useful leads
for those working in developing countries.
Groups requiring psychosocial support
Psychosocial support at the site of a disaster
should in principle be earned out by the rescue
workers and emergenev health personnel. The
leader of the mental health team with collabora
tors should establish the priorities- of
psychosocial support activities, mainly based on
their evaluation of the particular traumatic as
pects of the disaster, taking into account the
different groups which are to be considered:
1. The next-of-kin
2. The injured survivors and their close ones
3. The uninjured survivors
These groups are likely to have suffered the
most severe stressful experiences and thus require support and preventive activities. Often a
family may include all three above. Other groups
need to be considered, but they usually have less
pressing needs, namely:
7. Health pcrsonncl{mass injury situations that
• demand difficult prioritizing)
,—
8. Persons holding responsibility
9. Workmates (in company disasters), and
10. Evacuees.
Individuals at the’disaster site displaying
grossly deviant behaviour or other severe psy
chological reactions should be rapidly re
ferred to psychiatric care.
Establishing an information/support
centre
This centre can be located either at a hospital or
at a convenient place not too far from th? disas
ter area, (hotel, town hall school, etc.) but never
theless far enough away from where rescue ac
tivity is taking place, so chat congestion and
interference is reduced. If the identity of the
dead is uncertain (which is frequent), or the
number of dead is unknown for a time, a great
number of families will be distressed until they
ascertain that their missing family member is
safe. Establishing an information support cen
tre has turned out to be useful. The existence of
such a centre and its telephone numbers should
be distributed by radio and TV. Families who
are worried that one of their number is amongst
the victims should be invited to come co the
centre. Survivors may also be asked to gather
there. Particularly after cransport/communicacion disasters when people die far away from
their homes, this centre may be useful, for sev
eral reasons: it gives the bereaved a chance co
meet survivors to get a first hand report about
what happened to their loved ones, how they
died, perhaps even what they uctered before
they penshed, and what was done co rescue
them. The survivors and possibly also onlook
ers and rescuers have information that often
cannot be given bv others.
For the sun'Ivors it is often an important
experience to be of help to the bereaved.
The mam functions of such an information/
support centre are:
....l...T.o.proy.ide rapid, authoritative information
about tragic news chat can be conveyed in a
humane, direct way in a setting sheltered
from public and media attention,
4. Onlookers (particularly at risk are the help
2. To provide support and a holding environ
less helpers)
5. Rescue teams (particularly when failing to
ment tor both survivors and helpers,
3. To serve as a forum or meeting place where
affected individuals and families can support
each ocher. Self-help groups may develop
from this forum,
rescue, especially children)
6. Persons doing body handling (particularly
when they are non-professionals)
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
4. To be a place where the police can collect
identification data about missing/dead per
sons from their close ones,
5. At times the police should be able to use the
centre to interrogate survivors about the disastrous chain of events as a part of their
investigation,
6. The information/support centre should help
to reduce the convergence of people on the
disaster site that may create congestion and
therefore movement problems for rescuers.
A meeting may be organized for everyone
affected (this may be possible for up to one
thousand people) or at least one or two repre
sentatives from each affected family. At such a
meeting information can be given about rescue,
identification, investigation of causes, insurance,
psychosocial support services and religious ser
vices.
Attempts can also be made for early identifi
cation of persons at risk. The Post-Traumatic
Symptoms Scale - 10 for instance, can be used
after a few davs. The survivors’ mental state can
be evaluated, as can the possibility for mobiliz
ing social support from people’s own networks
(family, work colleagues, friends, neighbours).
Specific procedures for helping survivors
The mental health team should reach the scene
of the disaster as soon as possible. There have
been very positive responses to anticipatory
guidance, i.e., information about the natural
post-traumatic stress reactions that may be ex
pected. Information meetings are effective means
to talk about this and what the survivors them
selves and their close network can do to help.
Anticipatory guidance works by helping the
victim accept the reactions as normal and ex
pected, and not as pathological, thus reducing
uncertainty and feelings of helplessness. Night
mares suffered by the victim are often alleviated
by physical contact; if this fails it may be better
to wake the patient and let him go back to sleep
again afterwards. Hypnotics may be given briefly
for severe sleep disorders.
At this early stage most survivors are psycho
logically open and willing to talk about their
experiences, an attitude, however, that may soon
change into a defensive, withdrawn, non-coop
erative position if rime is allowed to pass with
out attempting to make contact. Therefore it is
of utmost importance that the survivors are
encouraged to seek help if problems develop.
14
When disasters involve people away from
their home areas, it may be necessary to help
them to establish supportive contacts with health
or social service, professionals in their home
district. One of the first needs of survivors in
these circumstances, is to be able to inform their
families about their fate, preferably even before
the media have announced news of the disaster.
Some may have an urgent need to get home
themselves. This makes organization of a mental
health support service more complicated than if
the victims are local people or members of a
homogenous social system.
Help for bereaved families
It has been demonstrated quite clearly that the
family is the unit providing the most important
source of strength for enduring a disaster, loss.
There is strong evidence that sudden and violent
death causes more pathology in the bereaved
than expected losses and this can be made worse
by the ternble circumstances surrounding the
death in disasters, perhaps even witnessed by the
family. Equally distressing however, are deaths
happening far away from them, possibly with
times of waiting and uncertainty for the family
•11
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Sometimes the bereaved may be unable to
travel to the site or they may never see the dead
because the remains may not be identifiable or
even found. Frequently, this failure to retrieve
the body or to identify the remains has compli
cated grief work. In the acute phase, measures
taken to alleviate the consequences should have
as the first goal, to help the family fully grasp the
death of one or more of their number, and
secondly to help start them on the road to
accepting the loss. The full realization of the loss
seems to be helped by the identification of the
dead body and an awareness of the physical
aspects of death, as well as the circumstances in
which it happened.
Experience in Norway
The psychiatric team working with the be
reaved families after a disaster, (the loss sup
port group), usually sets up its headquarters
at the local hospital, for example in the out
patient department of internal medicine. Each
team consists of a psychiatrist, chaplain
(priest), psychiatric nurse, clinical psycholo
gist and sometimes a social worker or others
experienced m loss and grief reactions. Gath
ering the bereaved families in one place pro-
PSYCHOSOCIAL INTERVENTIONS IN DISASTERS
' • •• f9
tects them from wandering aimlessly around
or engaging in unplanned searches for miss
ing family members. Some experience indi
cates that the support group should work
exclusively with the bereaved families and
not combine this work with support to survi
vors, because of the entirely different needs of
the clients. Each family has two group mem
bers designated as personal contacts. The
group will work in close cooperation with the
police which is the agency that carries out the
identification work.
In disasters where people die away from their
homes, the team will have some hours to
organize the reception of the bereaved fami
lies. If there is a large number of dead, it is
important to join the different families into a
cohesive group by, for instance, lodging them
m the same hotel. If the dead come from a
similar background, as in a school-bus acci
dent, the parents will already have a natural
affinity with each other, and this will
strengthen the bonds for an extended period.
If the dead make up a group which has come
together by chance however, as in a some
airplane crashes, the bereaved may form a
group onlv during the acute phase when they
are sharing many of the same services and
undergoing many of the same experiences.
The first dav
after a disaster is usually
filled
>
J
with a succession of practical problems to be
solved. The bereaved families are encouraged
to travel with a companion (who might be a
local priest or a friend of the family), because
it has been shown that the breaking of the
strong bonds that often anse between the
team and the bereaved family will be made
less difficult in the aftermath of the event
when a continuing link to an after-care service at the home place is provided through
this person.
Role of the Psychosocial Support Team
The psychosocial support team may be involved
in the following activities for the bereaved farm-
lies:
Notification of death
Seeing that this duty is carried out in an appro
priate way by me local police, priest, etc. It is
important that notification is given in such a way
that the family can be helped co grasp what has
the full facts about the death; this is a burden for
both parties involved. If the body has not yet
been recovered, the next-of-kin will nearly al
ways express a strong, wish co travel to the scene
of the disaster.
Identification of the body
A member of the team should be present when
the next-of-kin is asked by the police to make a
positive identification of the body.
Viewing the dead
It is important that the bereaved are provided
with an opportunity to see the body of the dead
if they wish and if this is possible, and that they
are provided with information about the death.
It is also important that as far as possible, appro
priate funeral and mourning rituals are provided
in accordance with the practice of the bereaved’s
culture. An important task for the support group
has been to arrange for this viewing of the dead
bodies. This must be scrupulously planned after
evaluation of each family and considering the
state of the body. Meeting the dead gives the
family a chance to see, talk and touch and to fully
comprehend chat the loss is real, that the uncer
tainty is over, and that they must take a final
farewell. If the face is coo mutilated to be seen,
ocher parts of the body may be recognized. For
children it can be a help co leave someching in che
coffin, a favourite doll, a drawing or a letter to
che dead mother or father.
Information about the circumstances of death
Regularly the family has many questions about
how che dead person was found and che manner
of death. Therefore they should be given an
opportunity to meet survivors who have some
thing to cell, che rescuer who found che body,
and any nurses and doctors who cried co resus
citate the victim. It may be necessary co ask the
pathologist co provide information.
Visiting the site of death
The team normallv encourages viewing of the
scene of che disaster co be carried out in groups,
and a rather private memorial ceremony may be
arranged there. This allows the bereaved fami
lies to come close to their dead and express their
solidarity.This final farewell mustbeshielded as
much as possible from che intruding gaze of
outsiders and the media.
happened. It is a common experience that the
Public memorial service
bearer of the sad message is not in possession of
The bereaved families should also be helped co
15
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
attend some kind of public memorial service.
Public mourning is an important symbol of the
wider society’s support to those bereaved.
Personal relationships are particularly im
portant in the emotional reactions after disas
ters, providing support and help in dealing with
the stress. People are also very distressed when
separated from those they love during and after
a disaster, and information and support services
to help the reunion of family members arc likely
to be helpful. Special relationships and closeness
between people of all social groups who have
suffered the same stressful experience together
may provide a “therapeutic community” effect
after the disaster, where people talk through
what has happened, share feelings and support
one another in several ways that may help recov
ery. Similar bonds may be formed between vic
tims and rescuers.
The physically
injured
%
Many hospitals are capable of handling 20 or
more injured cases, but not many can take care
of the one hundred or more close family mem
bers belonging to this number of injured. This
mav be 2 reflection of rhe usual emphasis on
physical injuries in disaster planning. The surgi
cal and intensive care personnel should there
fore be reinforced by a psychiatric liaison team
who can have responsibility for both the injured
and for their family members. As regards han
dling the injured, the most common error in
psychological handling is leaving the injured
alone; they are especially vulnerable to being
abandoned in darkness.
Crisis intervention
“The good talk” is the psychotherapist’s main
tool. It is as important as the scalpel to the
surgeon and contains several therapeutic ele
ments: the interpersonal contact, the verbaliza
tion which increases control, the cathartic effect
of ventilating emotions and the need for working through the experiences again and again, if
the fragmented and overwhelming impressions
are to be neutralized and integrated. To turn the
passive reliving of the trauma, as in nightmares,
into an active reconfrontation seems to work
well if the patient feels that the therapeutic envi
ronment is sate enough. It is natural to use the
group approach with victims of collective trauma
because, having faced danger together, strong
bonds have been created between them.
Debriefing
The majority of rescuers report a need to work
through the emotional disaster experiences by
sharing their feelings with others. Debriefing
should aim to:
— review the helper’s role;
— ease the expression of feelings;
— explore particular problems encountered and
solutions found;
— identify positive gains;
— explore consequences of disengagement;
— identify those at risk;
— provide education about normal reactive pro
cesses to acute stress;
— explain how to cope with stress adaptively.
The psychiatrist can act as the formal leader
of the debriefing group or may give training to
professionals in rescue organizations so that
they can lead such activities. Frequently it is a
great advantage to have taken part in the rescue
operation when leading such a group, but there
may be occasions when a neutral professional
should take on this role. Debriefing involves
going through, in detail, the sequence of events
as experienced by each participant. 1 he rescuers
should also share with the rest of the group their
thoughts and feelings during and after the disas
ter. It is generally easier to begin the debriefing
by first reporting factual information. The de
scription of the professional activities of the
rescuers can lead on naturally to the more deli
cate issue of their emotional and psychological
reactions. Reviewing how helpers felt and coped
requires consideration of positive as well as
negative aspects. On the negative side, these
individuals may have experienced a sense of
despair, a fear of being useless and overwhelmed,
or they may be having problems at home be
cause of their involvement in disaster work.
Some may suffer from what has been called
“perrormance guilt” believing that their contri
bution was inadequate. Positive reactions mav
include a feeling of satisfaction of a job well
done, the finding of a victim alive, the forging of
important relationships among helpers, orasense
of reassurance about having been able to cope.
The sustained emphasis on the positive aspects
of the work provides a powerful antidote to the
sense of being overwhelmed, and helps to achieve
a feeling of mastery over the unpleasant features
or disaster work. The bnenng session should
encourage the expression or these positive as
pects. Sometimes a powerful continuing rela
tionship may develop between a helper and one
or more of rhe person rescued. Both this and
powerful relationships that may have developed
with other helpers can cause problems by cut
ting across family relationships.
Role of information
Accurate information is very important at every
stage of disaster response. As part of prepared
ness, people should be provided with clear in
formation about what to do in the event of a
disaster affecting their community. Such infor
mation should be relevant to disasters that are
frequenter likely to occur, but also be of general
utility for unexpected circumstances. It should
convey the nature of the threat and what to do
about it in simple and concrete terms. Informa
tion in the event of an imminentthreatshould be
reported through at least several channels in
cluding TV and radio and should be presented
by those who are seen as trustworthy leaders.
Training, including information on what to do,
should be incorporated into community life in
places which are frequently subjected to threat.
During disasters, particularly in developing
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— specially prepared brochures and pamphlets,
updated as necessary, should be widely dis
tributed to the population of the affected
areas, as far as possible in collaboration with
the local media;
— dialogue should be encouraged between the
•-*
about the events that are occurring. Rumours
are frequent, authorities give conflicting infor
mation and ineffective action follows. Illiteracy,
a multiplicity of languages or dialects and a lack
of media, can all contribute to difficulties in
disseminating information rapidly and accu
rately.
J
The responsibility for transmitting informa
tion rests with both public authorities and the
mass media. The authorities should take and
retain the initiative in communicating with the
public in the event of an emergency. Communi
cation within the government should be well
coordinated, and the authorities should seek to
establish aclimate or trust with the media, which
should handle the information given in an open
and unambiguous manner. To achieve these
objectives, the national authorities responsible
for the various aspects or disaster protection
should coordinate their actions as far as pos
sible. International organizations may also be
sending out information. Diverse interpreta
tions from the various national and interna
tional organizations of the potential public health
consequences or a disaster, can seriously con
fuse the public, and create difficulties for na
tional authorities.
Developing country populations are notori—
ously non-compliant with warnings for evacua
tion. While a variety of psychological mccha-- •
nisms can be invoke^to understand these reac
tions, a more concrete approach must also be
taken. The evacuation order expects the victim
to leave behind all his possessions with no pro
tection against looting. Often survival is depen
dent upon small-scale agriculture or livestock,
making it very difficult for people to leave be
hind all their wealth and means of subsistence.-Failures of prediction can also diminish trust,
when evacuation orders are given for events that
never occur.
Accurate, trustworthy, and easily understood
information about a disaster should be provided
to the population at a local level. Such informa
tion should be provided in collaboration with
local leaders and community representatives. In
particular
community, the authorities, scientists and
health professionals, as also envisaged by the
European Charter on Environment and
Health;
Possible adverse effects of public
information
■
• ■ •
Public information can however lead to adverse
psychosocial consequences by creating a sense
of confusion and mistrust. Reassuring asser
tions by experts may be contradicted by other
experts or by later events. It is the right, even the
duty, of scientists to give an opinion on a scien
tific matter, but they must do it in a way that will
avoid any- confusion between facts and judg
ments on facts. A further difficulty is in the
nature of communication between scientist and
non-sciendst. The latter may be trained to think
in arbitrary terms requiring “yes” and “no”
answers and they may in consequence be both
ered bv the scientist’s answers in terms of gradation and multiple qualifying considerations. This
pressure for what might be thought of as “bipo
lar” thinking and decision-making is bound to
be a source of great exasperation, misunder
standing and irrational decision: the authorities
feel they are getting answers which are impos-
-■ .PSYCHOSOCIAL CONSEQUENCES OF DISASTERS: PREVENTION AND MANAGEMENT
__
siblc to use, while the scientist feels he is being
confronted with unanswerable questions and
coerced .or tempted into committing himself.
In considering the provision of information
to “victims”, it is necessary to consider their
definition. Traditionally victims of a catastro
phe would be defined as those who were physi. cally touched by its effects. On the contrary,
however, the notion of victim cannot be limited
to those persons physically exposed to toxic
emissions or physically affected by the disaster.
The victim group of a major disaster potentially
encomoasses all those who receive the bad news
of the accident. For larger populations, the bad
news will not necessarily be accompanied by
directly visible events or damage. This is espe
cially the case of toxic/nuclear disasters, and
many of the following considerations refer spe
cifically to this type of disaster. The Chernobyl
disaster was especially striking in this regard. In
the first weeks and months after the accident,
very limited public information was provided to
the affected populations. Over the following
years however, these populations have been ex
posed to a barrage of information, with many
contradictory and inconsistent news items and
rumours, all of which have resulted in an information overload, me victims" therefore now
include large numbers of people who are suffer
ing because they think they may be affected by
the accident, but who in fact have never been
exposed to toxic levels of radiation.
International organizations with responsi
bilities in the field of public safety and health
have therefore a clear duty to provide both
general and specific background information.
Diverse interpretations from these organiza
tions of the potential public health consequences
of an accident could seriously confuse the pub
lic, and create additional difficulties for national
authorities. Accurate, trustworthy, and easily
understood information about radiation and its
'1.8
health effects should be provided to the populationatalocal level. Equally or even moreimportant, is the way in which the authorities should
present information if an accident occurs. In
many cases, people have been flooded with in
formation and nobody has shown them how to
deal with it. One of the few “principles” in this
field that seems to be useful is that comparisons
A
are more meaningful than absolute numbers or
probabilities, especially when these absolute
values are quite small. The key role which can be
played by an international organization is cru
cial at this level, since the information provided
■ by it is generally seen as more “neutral” and
“authoritative” than that coming from other
sources, and it can therefore facilitate public
compliance with necessary measures, prevent or
•minimize worries and fears likely to produce
extensive psychosocial consequences, and fi
nally help to restore a cooperative climate.
Building a better public understanding of
risks and informing the public correctly in the
case of an emergency is only a part of what needs
to be achieved if people are to be enabled to
respond more rationally to a future emergency.
The central issue then is how to facilitate an
evolution from the provision of information
and recommendations, to a situation of effective
learning, which allows people to develop better
coping strategies during and after an accident.
Setting up such effective learning implies more
than providing available knowledge of the risks
associated with industrial activities and sub
stances through improved risk analysis and as
sessment. It also implies improving the knowl
edge and understanding of the reactions and
needs of individuals and groups in times of
emergency.
This last supposes a substantial change in the
current methods of risk analysis, risk assessment
and risk management (See MNH/PSF.91 docu
ment).
TRAINING AND INFRASTRUCTURE
FOR A PSYCHOSOCIAL RESPONSE
IN DISASTER RELIEF
Training programmes for primary
health care workers and other relief workers
Target groups For training programmes should
come from both rhe health and other sectors as
the first group. These should include primary
health care workers, often medical doctors of
first aid teams, community nurses, or other
trained health care workers such as social work
ers, administrators from local and national ad
ministrations, policemen and firemen in reserve
teams.
Training programmes for health care provid
ers should include the health aspects of disasters,
general psychological and psychophysiological
concepts about people’s reactions after a disas
ter and other stressful situations, and variations
in the way different groups of people perceive
the nsk from different types of hazards. The
programmes should also include simple ways of
dealing with psychosocial problems and the
teaching of simple skills for the recognition,
possibly using a checklist, and the treatment of
psychologically distressed victims (interview
ing skills, counselling, brief and simple
psychotherapeutic methods, targeted pharma
cotherapy, group therapy, etc.).
For administrators the training can help them
to identify vulnerable groups, demonstrate the
reason whv mental health services should be
integrated into the general disaster plan and how
a psychosocial component can be included in a
•»
comprehensive disaster plan.
The training of general health workers in
mental health seems to be effective and long-
Planning and coordination of
interventions in case of disasters
A senior mental health professional should be
identified at a national level to head and plan
mental health resources and consulting for di
saster preparedness and relief measures. Since
national or local disaster teams are primarily
concerned with the provision of emergency
medical care and are often headed by a surgeon
for instance, it can be useful if the professional
coordinating mental health inputs is also a phy
sician (e.g.a psychiatrist), in order to be able to
operate more easily in these circles and within
the disaster circumstances. Such a specialist liai
son officer will take part m the multidisciplinary
decision-making groups and also coordinate
mental health aspects and mental health teams
when these are available, ivlosc importantly, he
or she can act as a consultant to train and support
the preventive and other activities of the pri
mary health care workers.
Attention should also be paid to the mental
health needs of the care givers themselves, who
•are-faced with’heavy-demands-during disasters
and who are themselves exposed to a substantial
nsk of stress-related disorders.
As for service planning, it must be remem
bered that sendees should be provided on the
basis of the actual needs rather than on the basis
of the demand: this applies both to the timing
and to the magnitude of the interventions (Ross
& Quarantelli, 1976).
A major boon for the overall field of disaster
prevention, preparedness and mitigation should
come from the UN General Assembly Resolu
lasting. In the context of a WHO collaborative
study in six developing countries, general health
tion 42/169, designating the 1990s as the International Decade for Natural Disaster Reduction
workers were assessed after training aimed at
improving their knowledge, attitudes, skills and
(IDNDR) (Lechat, 1990; WHO, 1989a, 1989b).
The objective of this decade would be to reduce
the loss of life, property damage and social and
economic disruotion caused bv natural disasters, particularly in developing countries. In the
context of the IDNDR, WHIO will play a major
capacity to provide mental health care; it was
shown that rhe improvement was maintained up
to follow-up at 18 months and was of equal
magnitude in all countries (Ignacio et al., 1989).
technical role in the health sector, including in
the specific area of mental health.
&
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS. PREVENTION AND MANAGEMENT
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Given the above constraints and consider
ation, the following points need to be high
lighted:
1. A long range plan, including a full scale men
tal health intervention strategy, should be
developed at national and international level.
Many preparatory steps must be taken. The
comments that follow present a progression
from the current position towards an ulti
mate goal which is unlikely to be fully reached
in less than 5-10 years.
the mental health officers at the national and
local levels, who in cum will take the responsi
bility for training the local health workers in
relevant mental health issues. The consultant
should make available appropriate materials.
Model 2 (National reliance)
Continuing efforts to achieve disaster prepared
ness even before a disaster occurs, should be
taken to ensure national capability for managing
the mental health consequences of disasters.
These include the development of appropriate
training materials (e.g.manual, slides, video tapes)
2. Concurrently work on preparedness response
which will be used to train national staff to be
and rehabilitation is needed, with the full
responsible for the disaster mental health activiunderstanding that these levels may proceed
at different paces and influence each other • ties within their home country. Without there
being a disaster, a workshop could be convened,
(e.g.while preparedness efforts are poor, re
to be led by one or more international consult
sponse measures may need to be emphasized;
ants with the national mental health authorities
when preparedness improves other response
and designated staff who would be responsible
measures may be reduced).
for a disaster mental health programme. The
goal of the workshop would be to develop the
3. Below, three possible models for a
appropriate training materials and plan for their
psychosocial response to disasters are de
use. When a disaster strikes a country, the inter
scribed; these may vary from country to coun
national consultant should no longer be needed
try and they will need to be adapted to local
and the country will have attained a greater
realities.
degree of self reliance.
Given that an international consultant does
Model 1 (International reliance)
not have to be recruited for work to be initiated,
This is the current structure seen in most devel
oping countries.
An international consultant may be called
upon to provide mental health assistance after a
disaster has occurred, typically to the Ministry
of Health, through WHO.'The consultant will
interventions can be implemented much earlier,
probably within one week of the disaster. It will
also be possible to involve the mental health
workers almost entirely in supervision and sup
port of direct service providers. .
To achieve Model 2, the following prelimi
meet with an emergency committee and will
acquire information on the country and the
nary steps are suggested:
disaster. The consultant can advise the national
Ministry of Health and the health authorities of
the disaster area (and a local mental health of
ficer if one exists) on the setting up of an appro
priate emergency structure for ensuring a
psychosocial component within the disaster re
lief operation.
The mental health workers in the area will be
involved m some direct patient care, but the
international consultant should promote the
development and implementation of a model of
1. Development of a core of training material
care in which the general or primary health
for national or Regional use: manual, slide set,
video, etc. These should be available for various levels of staff, e.g.
(i) the mental health professional;
(ii) the general health professional;
(iii) the auxiliary health workers;
(iv) the community (non-health) workers.
2. Compilation of a literature review accessible
to non-mental health professionals.
worker will take the responsibility for provid
20
ing mental health care to victims with the sup
port or mental health professionals. The role of
3. Workshop/conference on ^disaster mental
die international consultant will be of educating
leaders and/or persons designated by them.
health training” for the national mental health
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4. Specific allocation of money from the general
should be formed, rather than relying on the
health budget should be obtained in order to
national authorities when disaster strikes. This
implement the above mentioned plans.- '- — —requires-that the Ministry of Health organizes
training for selected Ipcal mental health officers.
Using this model, mental health intervenModel 3 (Local reliance)
tions can occur sooner. The mental health offic-
.
•••
»•
•
•
. ...
- ------
Later on, and in zones at clear risk for disaster,
ers will only be directly responsible for those
the local mental health team (if one exists) should- ' referred by the general health worker, including
be responsible for managing the psychosocial..., uhosercquiringhospitalization.Thegreaterproxcomponents of disaster relief in its area of reimicy to the community allows for a much greater
sponsibihty, and a local disaster committee
degree of community participation.
21
POSSIBLE RESEARCH PRIORITIES
•
•»
1. Much of the research on the psychosocial
effects of disasters has been earned outamong
Western populations. It is therefore impera
tive to carry out extensive research with popu
lations from developing countnes, those that
are most affected by natural and man-made
disasters, both large and small-scale; this re
search will allow the study of cross-cultural
variations in frequency, symptomatology,
temporal patterns and outcome of psycho
logical disorders, and will clanfy the moder
ating effect of culture on these disorders. This
research, to be practically and ethically fea
3. Investigations into physiological determinants
and correlates of psychological and psychiat
ric disorders, especially PTSD, so far mainly
laboratory-based, should be strengthened and
should be mainly clinically based. It would
therefore be useful to find reliable, valid and
feasible physiological measures of stress to be
used as diagnostic tools. For practical rea
sons, this research is more feasible with indi
vidual victims of a single trauma or in more
limited accidents or disasters occurring in
developed countries.
sible, needs to follow stnet guidelines, and
4. The diagnostic specificity of the symptoms of
should adopt a rigorous research methodol
ogy. To achieve this, every effort should be
PTSD also needs to be further explored, as
does the natural history of this disorder.
made to obtain reliable pre-disaster baseline
health data (preferablvfromvanous sources);
to have a control group; to have high follow
up response rates; to use a longitudinal de
sign, and to find valid screening instruments
to be employed as a first step in mass screen
ing programmes in the acute post-disaster
phase.
5. An impo
2.rC2.
especially among persons suffering from
PTSD: for instance, substance abuse, fre
quently associated with PTSD, has been in
terpreted as a long-term attempt to numb
oneself against intrusive images and ni^ht-
mares, thus representing a secondary' response
to primary PTSD symptoms.
2. Although there is agreement that social sup
port and intense kin relationships are highly
supportive and facilitate post-disaster recov
ery among victims, little empirical evidence is
available in this regard. Therefore, the spe
cific role of these variables m modifying the
overall frequency, severity and course of psy
chological disorders needs to be further explored, as do the importance of personal vul
nerability and prior psychopathology in their
occurrence. Specific groups, particularly de
pendent on social support (such as children,
the elderly, the physically ill) should be care
fully investigated.
22
6. The experience of facing a trauma as an indi
vidual, versus the effect of trauma when expe
rienced with others needs to be investigated.
7. Finally, treatment of the main psychological
and psychiatric post-traumatic disorders is
an important area for research. The main
psychotherapeutic and pharmacological treat
ment methods deserve detailed consideration
and need to be adequately tested and verified
tor cross-cultural applicability as well as for
general effectiveness.
,
~— •
-
—
——•
.
. •
•■.
—
.
-
z
-
•
•
Ahearn, F.L. (1981). Disaster and mental health:
pre- and post-earthquake comparison of psy
chiatric admission rates. Urban and Social
Change Review. 14, pp. 22-28.
Barton, A. (1969). Communities in Disasters.
New York: Basic-Books.
Berz, G. (1989). List of major natural disasters,
1960-1987. Earthquakes & Volcanoes, 20,226-
228.
Cohen, Raquel E. and Frederick L. Ahearn, Jr.
Handbook for mental health care of disaster
victims. The Johns Hopkins University Press:
Baltimore and London, 1980.
Duffy, J.C. (1988). Common psychological
themes in societies’ reaction to terrorism and
disasters. Military Medicine, 153, 387-390.
Fischer-Hornberger, E. Die Traumatische
y CO<^<C«'
■• jgg5%fr >
’
-
'
1
search, 32, 137-144.
Green, B.L. (1982). Assessing levels of psycho
logical impairment following disaster. Jour
nal of Nervous and Mental Disease. 170,544552.
Ignacio, L.L., De Arango, M.V., Baltazar, J.,
D’Arrigo Busnello, E., Climent, C.E.,
Elkahim, A., Giel, R., Harding, T.W., Ten
Hom, G.H.M.M., Ibrahim, H.H. A., Snruvasa
Murthy, R.& Wig, N.N. (1989). Knowledge
and attitudes of primary health care person
nel concerning mental health problems m
developing countries: A follow-up study.
international Journal of Epidemiology, Id,
669-673.
Korver, A.J.H. (1987). What is a disaster?
Prehospital and Disaster Medicine, 2, 152-
Davidson, J. (1992), Drug Therapy of PostPsychiatry. 160, 309-314.
Z
Goldberg, D. & Bridges, K. (1988). Somatic
presentation of psychiatric illness in primary
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153.
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REFERENCES AHO
SELECTED READING
■
• • opment.
..
.
•-
----- Agency for-International Development (1989).
Disaster History: Significant Data on Major
Disasters Worldwide, 1900-Present. Wash
ington, DC: Office of U.S. Foreign Disaster
Assistance, Agency for International Devel-
•
•
"
• I•
Lechat, M.F. (1990). The International Decade
for Natural Disaster Reduction: Background
and Objectives. Disasters. Volume 14, Num
ber 1.
Lima, B.R. (1986). Primary mental health care
for disaster victims in developing countries.
Disasters, 10, 203-204.
Neurose:vonsomatishen zumsozialen Leiden.
Bern: H. Number 1975.
Fraser, R., Leslie, I.M.and Phelps,D. (1942/43)
Psychiatric effects of severe personal experi
ences during bombing. Proceedings oj the
Royal Society of Medicine. 36, 119-123.
Frederick, C.J. (1981). Violence and disasters:
Lindemann, E. (1944). Symptomatology’ and
management of acute grief. American Journal
of Psychiatry. 101, 141-148.
Manni, C.& Magalini, S. (1989). Disaster medi
cine: A new discipline or a new approach?
Prehospital and Disaster Medicine, 4, 167-
170.
Immediate and long-term consequences. In:
Helping Victims of Violence. Proceedings of a
Perry, R.W. & Lindell, M.K. (1978). The psy
WHO Working Group on the Psychosocial
chological consequences of natural disaster:
Consequences of Violence. The Hague, 6-10
A review of research on rXmencan communi
April 1981, pp. 32-46.
ties. Mass Emergencies, 3, 105-115.
23
■jL—,*■
IM
n ■ ■
Illi
■ ■■■■
>———T^—■■—■»——————
,
PSYCHOSOCIAL CONSEQUENCES OF DISASTERS. PREVENTION AND MANAGEMENT
X
«•
V
"..
:,. r.'r’
•
,
-. *•
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z
Poumadcre, M. (1990). The credibility crisis. In
B. Segerstahl & G. Kromer (cds.), Chernobyl
and Europe: A Policy Response Study, Berlin:
Springer.
Quarantelli, E.L. (1980). Sociology and social
pathology of disasters: Implications for Third
World and developing countries. Disaster Re
search Center, The Ohio State University.
Paper prepared for presentation at the 9th
World Civil Defense Conference in Rabat,
UNICEF, Assisting in Emergencies, UNICEF,
1986, New York.
Ursano, RJ. (1987). Posrtraumatic stress disor
der: the stressor criterion. Journal ofNervous
and Mental Disease. 175, 273-275.
Weisaeth, L. (1989). A study of behavioural
responses to an industrial disaster. Acta
Psychiatrica Scandinavica. Suppl. 355,80,1324.
Morocco, 5 November 1980.
Radjak, Abdul et al. WHO Indonesia. Inter
regional workshop on disaster preparedness
and health management. WHO/Ministry of
Health Indonesia, Jakarta, 1987.
Raphael, B. (1986). When Disaster Strikes.
Hutchinson, London
Ross, G.A. and Quarantelli, E.L. (1976). Deliv
ery of mental health services in disasters: The
Xenia tornado and some implications. The
Ohio State University: The Disaster Research
Center Book and Monograph Senes.
Rubonis, A.V. and Bickman, L. (1991). Psycho
logical Impairment in the Wake of Disaster:
The Disaster-Psychopathology Relationship.
Psychological Bulletin. 109.(3), 384-399.
Schwarz, Robert Flood forecasting and warn
ing: the social value and use of information in
West Bengal. 1981. Geneva: UN Research
Institute for Social Development.
Solomon, S.D., Gerrity, E.T. and Muff, A.M.
(1992). Efficacy of Treatments for Posttraumatic Stress Disorder — An Empirical Re
view. Journal of the American Medical Asso
ciation, 268(5), 633-638.
WHO, ICRC (1989). Coping with natural di
sasters: the role of local health personnel and
the community. Geneva, WHO.
World Health Organization (1987). Eight Gen
eral Programme of Work, covering the period
1990-1995. Geneva: World Health Organi
zation.
World Health Organization (1989a). Intemational Decade for Na tural Disaster Reduction
1990-2000 (IDNDR). Geneva: PCO/EPR7
89.1.
World Health Organization (1989b). Resolu
tion on the International Decade for Natural
Disaster Reduction. Geneva: A/44/832/Add.l.
World Health Organization (1992). ICD-lOThe
ICD-10 Classification of Mental and
Behavioural Disorders: Clinical descriptions
and diagnostic guidelines, World Health Or
ganization, Geneva.
The following have also been published by the
United States National Institute of Mental
Health (NIMH)
NIMH (1981). Manual for Child health Work
ers in Major Disasters.
Stierlin E. (1909). Uberpsycho-neuropathischen
Folgezustande bei den Uberlebenden der
Katastrophe von Courrieres an 10 Marz 1906.
Zurich: Umvcrsitiit Zurich. 139 pp. Disserta
tion.
NIMH (1984). Disasters and MentalHeaIth: An
Annotated Bibliography.
• . •
NIMH (1985). Disaster and Mental Health:
Selected Contemporary Perspectives.
*7
United Nations Disaster Relief Co-ordinator
(UNDRO) (1984). Disaster Prevention and
Mitigation, VoLlI: Preparedness Aspects. New
York: United Nations.
.24
NIMH (1985). Innovations in Mental Health ■
Services to Disaster Victims.
ISSN 0.63-6510
Vol’ 5, No. 3
The Urban Disaster:
Preparing for the Worst
March, 1981
■?
"/
When natural disasters, such as earthquakes,
• hurricanes, and floods strike urban areas, the loss
ot life and property can be devastating. In urban
areas, it is often the poor who suffer the most
(Sause of the conditions under which they have to
are?. Yet, as this issue of TUE points out, much can
be done to mitigate the impact of both natural and
man-made disasters. We will also indicate where
more detailed information is available. *
According to a 1979 report of the United Nations
Disaster Relief Office (UNDRO), typhoons alone
did about US $10 billion worth of damage to South
east Asian countries during the 1960’s. The floods
which devastated the Philippines in 1972 are
estimated to have set back that country’s develop
ment efforts by three to five years. Honduras may
not yet have recovered the productive capacity
destroyed by Hurricane Fifi in 1974. The annual
growth rate of Central America as a whole is esti
mated to have been reduced by 2.3% between 1960
and 1974 as a result of natural disasters. Bangla
desh, Chad, and Ethiopia are other nations still
suffering from natural disasters encountered dur
ing the 1970’s.
[ While accurate statistics on this subject are
seldom available, the U.S. Department of State
estimated that between July 1, 1970 and June 30,
1971, over 51 natural disasters took place, causing
500,000 deaths and affecting 68,000,000 people. In
1973, there were 25 major disasters, killing over
100,000 people, while causing more than US $1
billion worth of damage to areas containing about
225 million people. The annual loss of life and
nroperty resulting from natural disasters is indi
cated in Figure 1, based on International Red Cross
statistics. It should also be noted that an estimated
95% of deaths from disasters occur within develop
ing countries.
/Ian Davis's SHELTER AFTER DISASTER, 1978 (Oxford
Polytechnic Press, Headington Oxford OX3 OBP, England) is an
excellent source of information. Mr. Davis (with Everett M.
Ressler and Ken Westgate) has also prepared a course of six
slide lectures, entitled HUMAN SETTLEMENTS AND DISAS
TERS, available from the Commonwealth Association of Archi
tects Projects Unit, 326 Grand Buildings, Trafalgar Square,
London WC2N 5HB, England.
Persons killed
Persons injured or
left homeless
Earthquakes
Volcanic eruptions
Floods
Landslides
Avalanches
Cyclones
Hurricanes
Typhoons
Storms
Tornadoes
2,662,165
128,058
1,287,645
3,006
3,059
434,894
18,513
34,103
7,110
1,175
28,894,657
337,931
175,220,220
44,673
150
17,648,463
1,197,535
5,437,054
3,432,641
342,459
TOTAL
4,579,728
232,555,783
Figure 1
Results of Natural Disasters Between 1900 and 1976
Worldwide
Urban areas appear to be hardest hit by earth
quakes and so-called “meteorological distur
bances” (hurricanes, cyclones, typhoons, or tor
nadoes). The earthquake that struck Managua,
Nicaragua in December 1972 killed more than
10,000 people. Guatemala suffered from an equally
devastating earthquake in February 1976, losing
over 200,000 dwelling units. At least one-third of
the estimated 1.2 million people left homeless lived
in Guatemala City, the country’s largest urban
area. About 40% of the city's housing stock or
60'000 dwelling units were destroyed. It takes many
years for a city to recover from such devastation.
In Guatemala City, many of the homes that were
destroyed were on hillsides without vegetation and
thus subject to erosion. Thousands died as land
slides took their houses down the slopes. Because
most of the houses were badly constructed, using
walls of unreinforced adobe, they crumbled with
the first tremor.
In Japan, on the other hand, houses are tradi
tionally built on solid foundations, using light
weight wood frame structures to withstand earth
quake tremors. In certain villages in India which are
subject to flooding, it is common for houses to
have raised floors (i.e., to be built on platforms) to
protect them from excessive damage. Many of the
streets are narrow and deep to drain away the flood
waters. Paved roads have been added to allow
quick evacuation; but tall evergreen trees are kept
for climbing to escape the floodwaters.
The Urban Edge is published monthly by the Council lor International Urban Liaison, 818 18th Street. NW, Washington. D.C. 20006, as aclearing
house for practical experience in low cost service delivery and employment creation projects in developing countries. Material appearing herein
may be reprinted with source citation. Copies of reprints appreciated. Herbert H. Werlin, Editor. George G. Wynne. Publications Director.
In Upper Volta, the United Nations has been
assisting the government in its efforts to steer the
growth of the capital city, Ouagadougou, aws(h
from areas subject to soil erosion and pollutiorT*
during flash floods. In the Tondo project in Manila,
the World Bank has assisted residents to decrease
the danger of fires by widening alleys, providing
fire hydrants, reducing the size of housing clusters,
requiring fire walls to be built, and creating open
spaces or greenbelts around hazardous fire areas.
In a low-income village within Bangkok, Thai
land, Dr. Shlomo Angel, an Israeli urban planner
employed by Bangkok’s Asian Institute of Tech
nology, has been working with residents to develop
a fire fighting system, using a water pump powered
by a rebuilt Toyota car engine.* With the financial
assistance of the Canadian government and sev
eral Thai agencies, residents dug tunnels, installed
pipes, and constructed sub-stations containing
hoses and extinguishers to be used with the five
fire hydrants placed strategically around the vil
lage. Officials of Bangkok’s Fire Brigade then
trained villagers in fire fighting techniques, which
they demonstrated by putting out a fire within two
minutes of the sounding of an alarm. A videotaped
program of this project is used by the Thai govern
ment to promote more such self-help projects.
Other possibilities for reducing the potential for
urban disasters are contained in a series of vol
umes recently prepared by UNDRO, entitled DI
SASTER PREVENTION AND MITIGATION: A
COMPENDIUM OF CURRENT KNOWLEDGE,
available from the New York or Geneva United
Nations Sales Section. Volume 5 (LAND USE
ASPECTS), Volume 7 (ECONOMIC ASPECTS),
and Volume 10 (PUBLIC INFORMATION AS
PECTS) appear to be particularly useful to urban
officials. Some of the recommendations empha
sized include:
o Vulnerability Analysis
In many cases, the residential areas where the
poor live are in sections of a city most subject to
flooding, fires, landslides and earthquake destruc
tion. These areas are also near important sources
of employment and to resettle the urban poor away
from these sections without considering the social
and economic implications, is likely to do more
harm than good.
To minimize the need for large scale urban
resettlement, UNDRO stresses the importance of
“vulnerability analysis,” including the following
steps: (1) scientific data collection in order to
prepare maps identifying the location and inten
sity of risk; (2) calculations of the costs and
benefits of alternative locations; and (3) feasibility
studies of ways to reduce existing dangers. Follow
ing a vulnerability analysis, various types of public
works or regulations may be introduced.
UNDRO has been working with Philippine offi
cials to develop a vulnerability map for Greater
Manila primarily for flood protection. This map will
indicate the most effective protective measures to
be taken in the process of developing urban plans
’Article by Nancy Nash in THE ASIA MAGAZINE, September
17, 1978.
2
and regulations. Such a map is intended to be
progressive in nature so that it can be periodically
adjusted to movements of population and major
construction activities.
Government agencies often combine fiscal or
financial incentives with building codes and zoning
regulations to guide development into safe and
desired areas. By the location of infrastructure and ,
services or by public land acquisition, it should be
possible to provide safe areas for low-income
housing. However, the right of pre-emption or
expropriation may be necessary to control land
use changes and the land market for disaster
prevention. Hazardous land may also have to be
acquired in this way.
.
o Improved Housing
VJe pointed out in a previous TUE issue (5:79)
that agencies and institutes in countries such as
Peru and Ghana are doing research on the design
of low-cost disaster resistant houses. A “safe
house” is estimated to cost 15% more to construct,
requiring the tying together of such building
components as roofs, walls, foundations, and~
frames to resist lateral and lifting forces of eai
" 1
quakes, winds, and floods. A training book th T
uses comic strip techniques to illustrate self-help
construction methods for such a house (see figure
2) is available in several languages from Oxfam, 274
Banbury Rd., Oxford 0X2 7DZ, England.*
Figure 2. Oxfam/World Neighbours Educational Comic Book #
Probably the most scientific study of methods to
construct low-rise buildings to better resist ex
treme winds was undertaken between 1973 and
1977 by the U.S. National Bureau of Standards with
the financial support of USAID’s Office of Science
and Technology. Much of the research was carried
out in the Philippines, using the wind tunnel at the
University of the Philippines. Five volumes
emerged from this study in 1977 and are available
from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402'
(SD Catalog No. 013/29/2:100).
Also see the 1975 United Nations publication:
LOW-COST CONSTRUCTION RESISTANT TO
EARTHQUAKES AND HURRICANES, ST/ESA/23.
•From an article by Ian Davis in DISASTERS, Vol 1 No 2
This is the leading international journal of disaster studies
available from the International Disaster Institute, 85 MarlebonA
High Street, London W1M 3DE, England
MARCH 1981
URBAN EDGE
These volumes show how strong, inexpensive,
locally available building materials can be inte
grated with good building design. The emphasis is
not only on appropriate materials but also on
cultural acceptance and the use of unskilled labor.
While this research is based on conditions in the
Philippines, Jamaica, and Bangladesh, it is ob
viously relevant to all countries experiencing ex
treme winds.
with some central point for journalists, broad
casters, and officials to get prompt, reliable an
swers to questions that arise. To improve com
munication and working relations, it is useful to
arrange periodic meetings for administrators, sci
entists, technicians, local political leaders, and
representatives of the mass media to discuss
disaster prevention and mitigation procedures.
° Preparedness Measures
According to research done by the U.S. United
Nations Association, only about one-third of de
veloping countries have national disaster organiza
tions and plans. Yet, the importance of predisaster
planning has often been shown. In the People’s
Republic of China, for example, the following steps
were taken to minimize the effects of a 1976 earth
quake which killed or injured about 400,000 peo
ple:*
“(1) Local people and authorities commenced
action while waiting for outside help.
(2) Immediate treatment of injured was carried
out and help given within the community.
(3) 20,000 medical workers were rushed to the
area from the surrounding countryside along with
all needed medical supplies.
(4) Efforts were made to rescue people trapped
in buildings.
(5) Special groups were set up to evacuate the
injured.
(6) A mass sanitation plan was put into action.
(7) The many dead were buried.”
To respond in this way, governments must take
the following steps: (1) maintain up-to-date infor
mation on health conditions, medical facilities,
transportation routes, local resources, channels of
communication, and other aspects relevant to
disaster prevention and assistance; (2) train offi
cials and local leaders in the assessment of
damage and needs, simple first aid and rescue
procedures, and implementation of relief efforts;
and (3) develop stockpiles of such items as con
struction materials, warm clothing, tools, and nonperishable food; and (4) inventory easily available
construction materials in the region.
&
Warning systems
Many lives can be saved by developing adequate
warning and public communication systems. India
has demonstrated the effectiveness of contacting
local officials by radio or telephone for flood
warning purposes and then relying on word-ofmouth to convince people to move to safety. A
simple warning system, using church bells and
village bicyclists, seems to work well on certain
South Pacific islands.
To be effective, warning messages should be
specific, consistent, urgent, and continuous, in
cluding information on what can be done to
prevent, avoid, or minimize the damage. They
should be disseminated through many channels,
•From the proceedings of a 1980 W.H.O. seminar in Manila,
Philippines available from its Western Pacific Regional Office in
Manila.
URBAN EDGE
•
MARCH 1981
Assisting Disaster Victims:
Appropriate Strategies
Alcira Kreimer has pointed out in several articles
(in EKISTICS, Nov./Dec. 1979 and HABITAT IN
TERNATIONAL, No. 3, 1980) that relief agencies
make too sharp a distinction between emergency
shelters and permanent housing in developing
countries.* The truth is that most of the urban poor
normally live in temporary dwellings on illegally
occupied land or within unauthorized settlements.
They must live this way because of the inadequacy
of financial institutions, infrastructure, services,
land use control, and access to employment.
Consequently, what disaster victims really need are
opportunities to improve their standard of living.
While tents and other forms of emergency shelter
may be useful for a short time, any program to
provide shelters after disasters should be inte
grated within more general urban development
projects. Paternalism must be avoided. Relief
agencies can do most good by mobilizing local
labor rather than by themselves undertaking re
construction. Instead of expensive prefabricated
dwellings, the use of local materials should be
encouraged wherever available, together with the
use of labor-intensive methods, in order to start the
construction of permanent dwellings as soon as
possible after the disaster. In other words, helping
people to help themselves is the most effective
form of relief. Effective assistance also necessi
tates:
o Adequate Information
The U.S. National Academy of Sciences (2101
Constitution Ave., N.W., Washington, D.C. 20418)
has recently published a series of volumes on
disaster relief. In its volume, ASSESSING INTER
NATIONAL DISASTER NEEDS, it presents three
categories of needed information corresponding to
three stages within an emergency period: (1) first
24 to 48 hours; (2) 48 to 96 hours after the disaster
impact; and (3) recovery and long-term rehabilita
tion requirements.
The following is a checklist of the types of infor
mation which when collected immediately after the
impact of a disaster can enhance international
relief efforts:
•professor Kreimer has sent to TUE’s editor a description of
her interesting project to study housing reconstruction in the
Dominican Republic and Dominica. Interested readers may
write to her about this at the Department of Urban and Regional
Planning, George Washington University, Washington, D.C.
20052.
3
1
“1. number of people injured;
2. location of the injured population;
3. accessibility to the disaster sites;
4. type and severity of trauma;
5. age and sex distribution of the injured;
6. extent to which local facilities can treat the
injured;
7. support needs (drugs, personnel, leadership,
etc.);
8. potential threats to survivors (e.g., after
shocks, further flooding, fire, disruption in ser
vices, damage to public utilities);
9. condition of essential lifeline systems (trans
portation to the affected area, communication
facilities, water and sewer systems, etc.);
10. inventory of medical supplies, health facilities,
and manpower at the site of the disaster and in the
remainder of the country; and
11.a housing losses and housing needs.”
In regard to long term recovery and rehabilita
tion, there must be continuous monitoring of short
term relief prog-ams to detect conditions that
could hamper recovery, thereby facilitating the
replacement or modification of counterproductive
relief measures. As time allows, needs and re
sources should be more carefully determined so
that they can be more adequately matched. Ways
should also be found to improve building practices
and to design and operate more disaster-resistant
transportation, communication, water and energy
“lifelines.”
o Appropriate Technology
As mentioned earlier, temporary housing sup
plied by foreign donors is often inappropriate. For
example, the polyurethane igloo-shaped houses
provided as temporary dwellings to families in
disaster-struck Peru, Turkey, and Nicaragua were
extremely dangerous because of the use of open
fires in these countries for heating and cooking. In
these and other countries, many of the tents
supplied were either unused or used by military
personnel rather than the victims for whom they
were intended.
In Guatemala, on the other hand, the iron
sheeting, timber sections, and tools provided by
Oxfam to earthquake victims were highly appre
ciated. The use of galvanized iron sheets, together
with wooden poles, for converting emergency
shelters into permanent housing has been demon
strated by Mr. Gurudev Singh of Ahmedebad’s
School of Architecture in the June/July 1980 issue
of AFFICHE.’ Using this progressive housing tech
nique, the occupant can add desired components
and rooms as and when building materials, time,
and finance become available. This design permits
the use of low skill technology, speedy erection
techniques, inexpensive materials, and variation in
dwelling form according to individual needs at all
stages of construction.
’This is an architectural journal concerned with human
habitation in developing countries. It is available from its editor
Adarsh Narayan, 10 Barley Mow Passage, Chiswick, London W4
4PH, England. Also see the National Academy of Sciences’ 1978
volume, THE ROLE OF TECHNOLOGY IN INTERNATIONAL
DISASTER ASSISTANCE.
4
© Appropriate Assistance
Mr. J. Dupaigne, the director of Martinique’s Civil
Engineering Department in Fort-de-France (P.O.
Box No. 661) has sent us an interesting description
of financial and technical assistance provided by
the French government to victims of cyclones
during 1979 and 1980. The objectives of this assis
tance were: (1) to identify those legitimately hurt by
these disasters; (2) to enable victims to quickly and
easily build cyclone resistant housing; and (3) to
rehouse those unable to reconstruct houses. The
following methods were used to meet these objec
tives:
(1) The use of investigators. A number of investi
gators familiar with construction techniques and
local dialects were employed. Each was provided
with a car and a camera and was responsible for
about 100 contacts per month. Through this
method investigators were able to identify owners
of destroyed housing, their social and economic
situation, and their capacity for self-help recon
struction.
(2) Indemnification in money and/or materials.
In most cases, funds were provided to families
capable of self-help building. However, these funds
were distributed gradually depending on the pace
and quality of construction. By virtue of periodic
supervision and guidance, most of those receiving
this help used it properly. In some places, because
of inadequate availability of materials, supplies
were provided instead of funds.
(3) Cooperation with local charities. For the
aged or handicapped and for those living on
unsuitable or unrestorable land, other arrange
ments were made with the assistance of local
charities, in some cases, housing which can be
temporarily rented has been made available to
gether with funds for this purpose. The preferred
alternative, however, is to give victims a small
house or a skeleton of a house which can be
enlarged by self-help methods.
International Relief Programs
Stephen Green prepared in 1977, INTERNA
TIONAL DISASTER RELIEF, a useful description
of existing programs for the U.S. Council on
Foreign Relations, 58 E. 68th Street, New York, N.Y.
10021. The following information presented might
be of interest to our readers:
• The United Nations Disaster Relief Office
(UNDRO)
UNDRO was created in 1971 in Geneva to
mobilize, direct, and coordinate responses of U.N.
agencies to requests from disaster-stricken states.
It also promotes the study, prevention, control, and
prediction of natural disasters. During relief opera
tions, the Resident Representative of the United
Nations Development Program (UNDP) ordinarily
becomes the local agent of UNDRO. However, the
U.N. Secretary General may appoint a representa
tive of another agency, such as the United Nations
Children’s Fund, the Food and Agricultural Organ
ization, or the World Health Organization, to
undertake this responsibility.
MARCH 1981
URBAN EDGE
During recent years UNDRO has developed a
working relationship with private organizations
through the so-called “Steering Committee,” con
sisting of representatives of the Oxford Committee
for Famine Relief (OXFAM), Catholic Relief Ser
vices (CRS), the World Council of Churches
(WCC), the Lutheran World Federation (LWF), and
the League of Red Cross Societies. This Steering
Committee, which meets in one of the offices of the
International Committee of the Red Cross in
Geneva, has become an important central coordi
nating body for worldwide relief activities. Besides
consulting regularly on relief operations, the Steer
ing Committee maintains relevant information
about dangerous conditions in developing coun
tries, national disaster plans, and strategies for
dealing with disasters.
UNDRO has been encouraging developing coun
tries to form permanent disaster committees,
within which private and public agencies can
establish arrangements for dealing with major
disasters. Currently, about 20% of the most disas
ter-prone developing countries have formed such
committees.
o The Red Cross
In most developing countries, the Red Cross,
which began in 1863, is the most active private
organization in preparing for disasters and in
carrying out relief operations. There are now
National Red Cross Societies in more than 125
countries, under which local Red Cross societies
operate in many cities in cooperation with local
officials.
National Red Cross Societies are united in a
federation, the League of Red Cross Societies.
Representatives meet every four years at an inter
national conference in Geneva to discuss relief
operations and joint actions. Between international
conferences, intra-Red Cross policy matters are
dealt with by the International Committee of the
Red Cross, which functions as the League’s secre
tariat under the direction of its joint policy coordi
nation committee.
© The Office of U.S. Foreign Disaster
Assistance (OFDA, USAID,
'
Washington, D.C. 20523)
The U.S. government has had a long history of
relief activities, beginning with a $50,000 appropri
ation in 1812 to help earthquake victims in Vene
zuela. However, until recently, most U.S. assis
tance has come from non-governmental agencies.
While much aid continues to be channeled through
private voluntary agencies (now grouped together
within the American Council of Voluntary Agencies
for Foreign Service, Inc., 200 Park Avenue South,
N.Y., N.Y. 10003), an increasing amount of assis
tance comes directly from the U.S. government in
the following forms:
(1) Surplus food. Public Law 480 permits gov
ernment held surplus food to be used to benefit
needy people, particularly disaster victims in de
veloping countries. USAID’s Office of Food for
Peace is responsible for authorizing and adminis
tering the use of food for emergency purposes via
free distribution or food-for-work programs.
URBAN EDGE
•
MARCH 1981
(2) Ambassadorial assistance. The U.S. Ambassador has the authority to spend up to $25,000 for
immediate relief when a disaster has occurred. This
amount can be given directly to the stricken
country’s government, or it can be made available
to the Red Cross or other voluntary agencies for
relief work. Beyond that, expenditures must be
approved by USAID’s Office of Foreign Disaster
Assistance (OFDA).
(3) Supply stockpiles. To save time, OFDA main
tains in Guam, Italy, Singapore, and Panama stock
piles of tents, blankets, coats, stoves, auxiliary
generators, plastic sheeting, water pumps, hand
tools, and medicines. How much of this material is
used during a particular disaster depends on
OFDA’s matching of requests with logistical re
quirements and other considerations.
In addition to coordinating relief efforts, OFDA
undertakes considerable research to develop tech
nology to monitor disaster-prone areas. By using
satellites and new instruments or techniques, it
informs foreign officials of possible earthquakes,
volcanic eruptions, droughts, or floods. OFDA also
undertakes many training programs and confer
ences for U.S. and foreign officials to facilitate pre
disaster planning and post-disaster relief.
o The World Bank
As indicated by its original name, “The Interna
tional Bank for Reconstruction and Development,”
the World Bank has always been concerned with
post-disaster relief. However, it is introducing new
approaches in its Urban Reconstruction Project for
Nicaragua where extensive damage was suffered
during its recent civil war. During the prolonged
fighting, considerable sections of most major
cities, particularly the low-income settlements
(barrios), were badly damaged or destroyed. As a
result of the war, the already limited access of
inhabitants to services, employment, and credit
facilities was much further reduced. In some
places, 90% of the smaller enterprises were ren
dered inoperative by damage to workplaces or
inventories, causing an estimated 60% of the popu
lation to be unemployed. With about two-thirds of
the country’s buses destroyed or severely dam
aged, many people could not reach jobs even if
they were available.
To assist the government in its reconstruction
efforts, the World Bank is lending US $22 million.
About half of this amount is intended to rehabili
tate Managua’s Public Transport System; one-third
is for repair and improvement of infrastructure and
urban services; the remainder is to be lent to smallscale firms or cooperatives for reconstruction,
replacement of equipment, and working capital.
To make these funds available as quickly as
possible, the World Bank is attempting to avoid
potentially delaying problems, such as land acqui
sition and complicated engineering requirements.
Procurement and disbursement flexibility is being
maximized, and components or subcomponents
are being simplified. Available help from USAID
and other international organizations is being
sought. In these and other ways, this project may
help to define strategies to facilitate reconstruc
tion efforts in other countries as well as Nicaragua.
5
>
Algeria: Reconstruction of El Asnam
In October and December 1980 property in the
Wilaya Governorate and in the town of El Asnam
(population 120,000) was seriously damaged by
earthquakes. A preliminary survey of some 8,000
buildings in the most affected areas of El Asnam
indicated 20% were sound (labeled green) and 24%
were total losses (labeled red): the remaining
56% (labeled orange) were in doubt. The Govern
ment is considering the need for survey teams
consisting of structural engineers, quantity survey
ors and artisans to survey the damage in the
buildings labe’ed orange, assess the feasibility of
structural repair and the cost of recovering the
building. The magnitude of the potential cost
savings in rehabilitation vs. destruction/reconstruction is considerable. Expatriate structural
engineers may ultimately be required, but the need
for a nucleus of structural engineers specializing in
this sort of work is clearly established and ideally
every country likely to be affected in this way
should have a register of qualified and experienced
structural engineers who can be called upon in an
emergency.
Earthquake Institutes
The following is from an article by Peter Collins
which appeared in the November 1980 Develop
ment Forum, available from DESI/DPI, Palais des
Nations, CH-1211, Geneva 10, Switzerland.
“Because of the enormous damage to property
and human lives that may result from a serious
earthquake, many countries have found it worth
while establishing specialized seismological re
search institutes. One of the most up-to-date in the
Mediterranean basin is at Skopje, Yugoslavia, a city
that was devastated in 1963, with the loss of over
1,000 lives. The Institute of Earthquake Engineer
ing and Engineering Seismology was set up in
1965, with the help of the UN Development
Programme (UNDP) and the UN Educational,
Scientific and Cultural Organization (UNESCO).
Its new laboratories, opened earlier this year,
contain a complete range of equipment for testing
all types of structures, either as full-scale replicas
of individual parts, or as scaled-down models of
such things as bridges or even complete buildings.
The equipment includes a giant “shaker", a kind of
oscillating table to reproduce the effects of an
earthquake of any intensity so far recorded.
“Computerization will also play a large part in a
new UNDP/UNESCO-sponsored project in south
east Europe aimed at setting up a communications
network for rapid data transmission and analysis of
seismic incidents. Covering Bulgaria, Greece, Ro
mania, Turkey and Yugoslavia, it also includes
cooperation in research and training in relevant
fields and, on the longer term, the development of a
basis for physical planning and building design to
reduce earthquake damage.”
6
Responding to Disaster:
From Myth to Reality
by Ian Davis
Mr. Davis, Principal Lecturer with the Depart
ment of Architecture at the Oxford Polytechnic
(Headington Oxford OX3 OBP, U.K.) has pointed
out in various publications that much of the help
given to disaster victims is misguided. It stems not
only from the pressure “to do something fast,” but
also from misconceptions of the real situation and
needs of the victims. Based on visits to a number of
disaster areas in 1976 during the critical periods in
reconstruction, Davis here attempts to provide
facts in place of the following myths extracted, with
his permission, from his book earlier mentioned,
SHELTER AFTER DISASTER:
MYTH
REALITY
ASSUMED SITUATION
ACTUAL SITUATION
(A) SOCIAL ATTITUDES
1. The public will show signs
of panic or will be dazed
into a state of inactivity,
2 Local organisations are
likely to be ineffective and
inadequate.
3. Morale is likely to be low,
with looting and other
forms of deviant behaviour;
a situation that rapidly
deteriorates into chaos.
4. People in a dazed condition
will be passive, awaiting
aid and assistance.
5. Following the disaster,
there will be acute short
ages of food, blankets and
medical supplies.
6. After a disaster, people will
eat unfamiliar food, from a
desire to survive.
7. There are serious risks of
epidemics, from bodies
lying in the ruins.
(B) RECONSTRUCTION
1. Some form of temporary
housing is needed prior to
reconstruction.
2. Clearing rubble is a first
priority once people are
rescued.
3. Crash reconstruction pro
grammes by agencies and
governments are a highly
effective way of solving
housing needs.
No evidence to support this
belief
The evidence indicates the
reverse.
Again the reverse is likely to
be true, except in droughts,
famines and refugee camps.
The reverse: the normal
reaction being a highly moti
vated self-preservation in
stinct, enabling people to find
solutions to their own prob
lems.
A variable situation, but in
most contexts goods will be
locally available (exceptions
may include widespread
droughts and extensive
famines).
The reverse: all nutritional
evidence suggests that people
behave more conservatively
than usual.
No evidence of this risk;
therefore no need to adopt
measures such as ignition of
ruins, which disrupt recon
struction processes by de
stroying building materials.
Reconstruction, in the third
world, usually start immedi
ately, and takes place irre
spective of government plans
for relocation etc.
Apart from clearing streets to
provide access routes, the
rubble is best left for recycling
into new homes.
The reverse is true. An
indigenous response will al
ways be the most rapid and
effective form of provision,
particularly of temporarily'
unemployed people to build
their own homes.
MARCH 1981
•
URBAN EDGE
1
Asqhar Ali Engineer
COMMUNAL VIOLENCE - Recounting Five decades of Carnage in India towards a Policy on
Pisa star management.
Introduction
Hundreds of people are killed every year in India in recurrent Communal Riots. There exists no
concept of disaster management for these manjmade calamities. It is high time that some definite
policy for management of such unnatural disaster? is evolved by the government.
Without understanding the causes of communal violence it will not be possible to evolve any rational
policy to control it. Towards the evolution of such !a policy it thus becomes necessary to throw light on
its causes. Etefore going into a discussion on the possible measures for disaster management in
respect of communal violence we will discuss the causes of such recurrent violence in
post-independence India.
Pre -Independence India and Genesis of Communalism
Communalism, as most of the scholars of this subject agree, is not a medieval but a modern
phenomenon. All researches in medieval history clearly show, that there were very few instances of
Hindu-Muslim riots in the medieval period. Two pajor riots between Hindus and Muslims reportedly
occurred in the early eighteenth century in Ahmedabad on the question of common wall between a
Muslim and a Hindu neighbour. Khafi Khan, a chronicler of the Aurangzeb period, has thrown light on
these riots. There was large scale destruction of properties. The entire cloth market belonging to the
Hindus in Ahmedabad was set ablaze. The culpri s were duly punished by the Moghul emperor Alam
Shah. One more riot was reported during the time of Nadirshah's invasion on Delhi. Some Hindus and
Muslims were killed in this riot. But there are no other instances of large scale communal violence in
the pre-British period.
Communal violence exhibit a oeriod of systematic occurrence only during the British
period. Several riots occurred from the late eighteenth century onwards specially in North India. By the
later half of the 19,h Century, communal violence increased and started spreading out from North
India to parts of the then Bombay State. In 1893 Bombay witnessed large scale violence which spread
* to Junagadh and some other parts of the present cjay Gujrat.
Why did communalism and communal violence* increase during the British period? Many scholars
maintain that communalism is a modern phenomenon. It’s genesis can be traced to the colonial period.
The Marxist scholars maintain, that since there were fewer jobs and more claimants from both the
main religious communities, communal attitudes were born. According to them the stunted growth of
industries during the colonial period gave rise to communalism. Also that the British policy of divide
and rule played a vital role in the perpetuat’on of communalism.
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This analysis however cannot provide the key to the understanding of the complex
phenomenon of communalism. The elites of both the communities played an important role in
promoting it. Before the arrival of the EJritish, caste and regional identities or identities based on
biradaris took more important place than religious identities especially among the people of lower
castes. Thus we often come across terms like Rangrez Qaum (dyers' community) or Tanboli Qaum (
those selling betel nuts) or Teli Qaum (Oil Pressers) etc. These identities were more important for the
low caste Hindus and Muslims than the *eligious identities. But for Ashraf Muslims (i.e. Muslims of
higher social status) and Hindus of uppei castq (Brahmins and others) religious identities were more
important. Even among them caste and sect arian identities had its own importance. There was,
however, no religious divide.
Things changed with the coming cf the British for a number of reasons. The British rulers
partly out of ignorance of the Indian society anc partly out of political mischief attempted to create an
identity of homogeneous religious communities, which did not exist. The seeds of Communalism lay
therein. The Homogeneous 'Hindu community' or 'Muslim community' whh uniform political interests is
at it’s best, a political myth. Both communities were internally divided along regional, linguistic,
sectarian and caste lines.The British rulers identified Hindus and Muslims as two distinct communities
with divergent political interests. The native pre-British rulers had not indulged in such political
categorisation. It is also important to note that for long no such division existed in the South. Thus
communalism was a north-centred phenomenon.
The upper class, upper caste elites from the North used these categories for winning
maximum concessions from the British rulers.'They, in their own inteiests, helped create separate
'Hindu' and 'Muslim' identities. The diffused composite identities specially among the low caste Hindus
and Muslims were sought io be erased and new pure 'Hindu' and pure 'Muslim' identities were sought
to be created by these elite by launching 'shuddhi' (purification) and 'tablighi' ( preaching) movements.
These movements mostly launched by the urban elite widened the gulf between two communities and
created artificial identities. This helped generate communal categories which intensified communal
feelings.
As the freedom struggle intensified ;the British felt insecure and used these categories to
divide Hindus and Muslims. Similarly, the elite of the two communities intensified their communal
demands for exacting maximum concessions and constitutional guarantees. The elite of the two
communities divided our country.
I
Our attempts to create a modern nation were marred by communalism and the communal question
became the most important question on the eye of independence. Mr.Jinnah, the Muslim League
Supremo, went to the extent of propounding a two nation-theory - Hindus and Muslims being two
separate nations. This was, in a way, culmination of the process of homogenising the two communities
which began in early nineteenth century. Communalism emerged as a by product of nationalism
during colonial years.
I
Communalism can then be seen as an outcome of the clash between the elite interests from the
two communities rather than clash of religious beliefs. The communal discourse is not a religious but a
political discourse. The Muslim religious divines - the 'Ulama - did not side with those Muslim elites
who translated separate religious identities into incompatible political identities. These religious divines
like Maulana Husain Ahmad Madani, Maulana Abul Kalam Azad and others maintained that
nationalism was a political and not religious category and hence composite nationalism was in no way
incompatible with religion. In fact they argued that the Prophet of Islam himself created a composite
political community —in• Madina.
Since communalism
is a product of clash of interests rather than clash
••
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of religious beliefs its architects are political and not religious leaders. Thus Jinnah, a politician
representing upper class Muslim interests, became architect of Pakistan and not Muslim religious
leaders. Similarly it was Hedgewar and Sawarkar, who became spokespersons of Hindu communalism
than any Hindu religious leaders.
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Communalism and communal violence are two stages of the same phenomenon.
Communal violence can be provoked only If communal feelings exist intensively among a section of
the community. Since communal discourse was being employed by a section of Hindus and Muslims,
intense communal feelings were generated resulting in communal violence on petty questions like
music before mosques, cow slaughter etc. In fact these were not the actual but instrumental causes of
riots. Before partition several communal riots took place, both major and minor, on such questions.
Post Partition Period : Role of Mainstream Political parties and Beginnings of Fundamentalism
It was expected by the Congress leaders like Pandit Jawharlal Nehru and others that partition will solve
the communal question and that India after independence will be free of communal virus. This was, at
best, an expectation. Nehru also thought that the remnants of communalism will disappear with spread
of education and science and technology. However, nothing of the kind happened.
There were various reasons for this. Firstly, the partition left deep scars on the Hindu psyche and a
section of Hindus held all Muslims responsible for partition. They thought that Muslims in India are, by
and large, supporters of Pakistan. Secondly, a large section of the Congress leaders were themselves
affected by communal virus. Even person like Nehru could not reform them. In fact some of them were
his rivals in the Congress Party. Nehru repeatedly wrote letters to the Congress Chief Ministers in this
connection but did not succeed in changing their attitudes. Govind Ballabh Pant, for example, turned
deaf year to Nehru on the Babri Masjid issue which again exploded in late eighties in a big way. If Pant
had been honest to the Congress ideology he would have got the Ram Lalla idols removed from Babri
Masjid which were planted there in December, 'i948.
Thirdly, political and economic competition again started between Hindus and Muslims
resulting in spread of communal ideo’ogy. Though as pointed out before, the Muslims were far from
being homogeneous politically, linguistically and culturally, were perceived as such and the Hindu right
posited the Muslims as being antagonistic to the Hindus. These constructed communitarian categories
continued to keep communalism alive and kicking in the post-independence period as well. This
communal discourse pitted the two communities against each other. They were thought to be political
foes.
Fourthly the RSS formed by Hedgewar in 1925, though temporarily banned after Mahatma
Gandhi's assassination, was allowed to function'again and it began to flourish. Its sarsanghchalak Guru
Golwalkar wrote in his book We, Our Nationhood Defined that Muslims and Christians are guests in this
country and that guests should not overstay and tax hospitality of the host. Muslims were, according to
the RSS, invaders from Arabia and Cential Asia and as invaders they had no place in Indian society.
Moreover, according to the RSS Muslims divided the Akhand Bharat and they are coming in the way of
akhandta (oneness) of the Bharat Mata (Indian motherland). Guru Golwalkar preached that either
Muslims in India should be deprived of their citizenship rights and allowed to live as non-citizens or
they should leave India.
■
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The RSS propaganda reached millions of people through thousands of RSS shakhas
throughout India. Moreover, it caught young Hindu children and drilled these ideas into their minds and
..
..
!
3
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they grew up with such communal attituce. The school text books also distorted Indian history and
portrayed Muslims as invaders and persecutors of Hindus and rapists. Unfortunately neither Nehru nor
Indira Gandhi ever succeeded in removing these text books. Thousands of students study these text
books every year and grow up with these idqas about Muslims. One can imagine what damage
continues to be done year after year and how difficult is to build a secular society.
I
COMMUNAL ASSERTIONS
OUTCOMES
IN
POST INDEPENDENCE
INDIA
:
EVENTS
,CAUSES
AND
India witnessed communal violence on account of partition right upto 1948.
(Post Partition Communal Riots in India)
Major riots took place on the eve of partition. Thousands were killed on both sides. In Calcutta the
Muslim League gave call for direct action in 1948 resulting in great slaughter of human beings. The
Hindus retaliated and the riots were intensified. Similarly Noakhali in Bengal and several villages in
Bihar too faced communal catastrophe. The refugees coming from West Punab in Pakistan retaliated
and Delhi witnessed unparalleled communal frenzy in which thousands were killed. The law and order
machinery had absolutely broken down. The authorities threw up their hands in despair. What was
worse the law and order machinery itself was split on communal lines. However, these were partition
riots and bloodshed on such scale never repeated again. The authorities, it must be said, did not
anticipate such communal massacre and were, hardly equipped to meet with such a catastrophic
events.
|
I
The partition riots, as pointed out before, were an exceptional phenDmenon and they could not be
bracketed with other communal riots. There was lull on communal front for the time being after
partition riots.
During fifties India did not witness major riots though skirmishes between the two communities
continued to take place. According to the Sixth Report of the National Police Commission (Government
of India, 1981) there were in all 84 communal incidents in 1954 in which 34 persons were killed and
512 injured. In 1955 about 75 riots took place in which 24 persons were killed and 457 were injured.
Nineteen fifty six saw in all 82 incidents in which ^5 persons lost their lives and 575 got injured. There
were 58 incidents in 1957 in which 12 persons were killed and 316 injured. In 1958 only seven persons
were killed in 40 incidents and 369 were injured: The year 1959 had in all 42 incidents causing 41
deaths and injuries to 1344. But in 1960 only 26 riots took place accounting for 14 deaths and 262
injuries.
;
Thus it will be seen that maximum casualties between 1954 and 1960 took place in the year 1959
when 41 persons died and 1344 got injured. These casualties were nothing compared to the major
incidents which began to take place from early sixties. The reasons for low intensity riots during the
decade of fifties immediately after independence '.were many. One of the important reasons was that
after the major cataclysmic event of partition there was no burning issue on which the communal
cauldron could again boil over. The Muslims themselves were terrified after the partition riots and were
maintaining a very low key political profile. Also,I most of the Muslim demagogues had migrated to
Pakistan and those who stayed back had gone through fire and were not prepared to risk another
confrontation. The Congress Muslim leaders were of course supporters of secular politics and were
advising Muslims in India to be part of secular derpocratic politics and give up separatist trends, if any.
Thus Mir Musntaq Ahmad, a Muslim leader from Delhi wrote in 1952: "The time has... come when the
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bells must toll for the Muslims, too. Let them hed their independent political entity and come out of
their isolationist groove of sect, community and the like...throw in their lot with the social philosophies
which are making a bid for economic emancipation through a gigantic movement of Indian peasants,
working class... and thus gain for themselves their rightful place with the afflicted millions of this
country." (Mir Mushtaq Ahmad to Ashok Mehta, 19 June,1952, Mushtaq Ahmad papers,NMML).
Similarly Dr.Zakir Husain advised Muslims to be an integral part of secular India and he undertook
to build a united nation in a democratic secular State and the role and status of its forty million Muslim
citizens within it, to weld together diverse cultures into a harmonious whole and to promote its growth
'in such a manner that each culture shines and lends beauty and strength to the entire whole.'
(A.G.Noorani, President Zakir Husain - A Ques^for Excellence, Bombay,1967).
Thus it will be seen that such sane advises tendered by Muslim leaders like Zakir Husain, Maulana
Abul Kalam Azad and others had great impact on the minds of Muslims and they avoided any kind of
confrontation with the majority community. Also, during the fifties other major controversies arose
which engaged the attention of the entire nation. The Linguistic reorganisation of states generated
several controversies. The reorganisation of Punjab and the Bombay state, for example, proved to be
highly difficult job. Master Tara Singh undertook fast for inclusion of Fazilka and Abohar in the Punjab.
The Maharashtrians demanded inclusion of Bombay into Maharashtra and not in Gujrat. Linguistic riots
broke out on large scale in Bombay. Several people were killed in these riots. These controversies
occupied more political space than communal controversies during this period and hence the decade
of fifties proved to be comparatively less hot cpmmunally. The loss of lives was minimum during this
period.
However, things began to change from early
sixties. The communal politics surfaced again and began to occupy major political space. As pointed
out before, the potential for communalism and ^communal violence increases with increased political
and economic competition between the elites of the two communities. By the early sixties Muslims had
also overcome the fear of communal holocaus during partition and had begun to rec.ain confidence.
Some of them were also regaining some of the lost economic space. The first major communal riot
thus took place in Jabalpur in Madhya Pradesh. Madhya Pradesh is also part of Hindi heartland, also
called cow-belt. The Jabalpur riot of 1961 was the first major riot of the post-independence India.
1960s : The period of Communal Reassertion :
In the sixties, high casualty in the WB riots between January to March 1964. 264 killed in Calcutta and
346 in Bihar and Orissa. August 1967, 200 were killed in Ranchi. November 1969, 1000 killed in
Gujarat. 79 April 117 killed in Bihar. August '980, 119 killed in Moradabad. September 1982, 100
killed in Meerut. 1982, 1026 killed in Meenakshipuram. May 1984, 230 killed in Maharashtra, October
1984, 1277 killed in Delhi and other places, May 1987, 100 killed in Delhi and UP, 1026 killed in
Bhagalpur in 1989, October 1990, 87 killed in Bijnore. December, 1990, 200 killed in Hyderabad, 100
killed in Aligarh, December, 1992, 200 killed in Bombay, Maharashtra, 300 killed in Surat, January,
1993, 215 killed in Gujarat, 557 killed in Bombay, 98 killed in Manipur,
(The Jabalpur Riot)
The Jabalpur riot, as far as its immediate cause was concerned, was result of competition between a
Hindu and a Muslim Bidi manufacturer. Before |we proceed further it would be in order to stress that
there are several factors behind a communal riot, local as well as trans-local or national. Also, there
are micro as well as macro causes behind any1 riot. We have riots which are systematically planned
and engineered by identifiable forces and there are riots which break out spontaneously, and even
unintentionally. It is much easier to control riots which break out spontaneously than those which are
5
6
well planned ones. Then there are immediate triggering events which are not the real causative
-factors. To properly comprehend the causes behind a riot, one must understand all this.
Also, rumours play an important foie in a genesis of any communal riot. Behind every
communal riot, there is invariably a role of rumour. No major communal riot can teke place without
spread of rumours. Sometimes even news papers, particularly the vernacular newspapers inflame the
communal passions by spreading false rumours in the name of news. There are several such instances
from Jabalpur to Meerut to Ahmedabad to Bhagalpur riots.
As far as the Jabalpur riot was concerned there were complex causative factors. One
cause was, as already pointed out, the competition between two Bidi manufacturers, one Hindu and
another Muslim. In fact the Muslim Bidi manufacturer was getting gradually greater and greater share
of this business and was trying to break the monopoly of the Hindu bidi manufacturer. Meanwhile it so
happened that a girl called Usha Bhargava, whp was studying in college became friendly with a Muslim
boy. Howeve; rumour was spread that the Muslim boy raped Usha Bhargava and eloped with her. This
rumour spread like wild fire and became the triggering cause of communal violence. This story of
elopement of a Hindu girl with a 'Muslim goohda' triggered the violence. The local Hindi newspapers
played very provocative role.
A senior journalist from Bombay lyir. S.B.Kolpe visited Jabalpur for investigation. It would
be interesting to hear the story from his pen to realise what role media plays in spreading communal
violence. Mr. Kolpe writes:
"Most of the newspaper reports were identical, obviously emanating from the same source. On
reaching Jabalpur....! found that two or three stringers working jointly for several national dailies were
responsible for these reports which had a damaging effect on the political life of a nation as a whole.
Only one of the three knew enough English o write readable reports, the others copied these with
minor changes.
The facts reported were collected from the, local police who were not free from communal bias. No
reporter bothered to verify the 'facts' doled out,to him....Some gave me the background material to the
riots which evidently commenced after Usha Bhargava committed suicide. There was an alleged
attempt at raping her by the two Muslim boys, according to a story originally put out by the local Hindi
daily The Yugadharma, a Jansangh-RSS paper, and picked up by other newspapers in Madhya
Pradesh and outside, while there were other rumours with their own versions.
According to the police the girl was friendly with one of the Muslim boys arrested in the case. She
had been seen with the boy at cinema house^. She may have had certain personal problems and in
that case any marriage was ruled out in the orthodox atmosphere of Jabalpur, that might have been
the reason for suicide One of the boys invplved was the son of an established bidi manufacturer,
whose factories in Jabalpur and neighbouring towns were burnt down by communal mobs, following the
publication of the rape report. The story did no| sound very convincing to me." (S.B.Kolpe, "Caste And
Communal Violence And the Role of the Press" in Asghar Ali Engineer ed. Communal Riots in
Post-Independence India (Hyderabad, 1991)
The role of the police in these riots was very partisan, specially the armed constabulary. It was
complained by several Muslim women that they barged into their he uses and molested them and
snatched their valuables, necklaces etc. The SRP, PAC etc. are known vor their anti-Muslim behaviour.
We will throw more light on this while discussing some other major riots.
(Ahmedabad Riots 1969)
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During sixties several riots took place most y in Eastern part of India like Jamshedpur, Rourkela,
Ranchi and several other places. The most snocking riot, however, took place at the end of sixties in
Ahmedabad in 1969. The background ot this riot was mainly political.
Mrs.Gandhi had split the Congress in 1968 and was looking for popular support among the people.
She tried to win popular support by nationalising banks on one hand, and by appealing to minorities
and dalits, on the other. This alarmed the rightist forces on one hand and, communal forces, on the
other.
These forces combined to either dislodge Mrs. Gandhi or to destabilise her government.
The best way to do so was to rock the country with communal violence and weaken the popularity of
Mrs.Gandhi's Government. The Ahmedabad riot really shook the country for several months. It created
shock waves. Gujrat was chosen for this purpose for several reasons. It had Hitendra Desai Ministry
which was anti-Mrs.Gandhi. Also Gujrat was ^astion of both Swatantra party - an extreme right party
and also of Jan Sangh and RSS, the Hindu communal outfits. All these forces were hostile to Mrs.
Gandhi and her political philosophy.
The Jan Sangh was also trying to capture Hindu votes by raising communal issues. Balraj Madhok,
an extremist among the Jan Sangh leaders had become the President and he was instrumental in
getting the resolution for 'Indianising the? Musims' passed. Thus the whole atmosphere in the country
was getting communalised. It was in this atmosphere that the riots in Ahmedabad broke out.
This communal catastrophe which claimed rpore than 1000 lives, began with petty incidents: a cow
kicking a Muslim child and as a result some Muslim men chasing the Sadhus and throwing stones at
Jagannath temple. A Muslim inspector allegedly kicking Ramayana.
It appeared as of the communal fijenzy has been let loose. The police force, barring a few
exceptions was communalised. The Gujrati mpdia became instrumental in spreading rumours. A police
constable who killed some Muslims was publicly honoured by some communal hot-heads. Many
newspapers wrote editorials questioning the loyalty of Muslims. All this provoked Hindus and some
triggering events built up mass frenzy among them. Throwing light on the death and destruction
Ghanshyam Shah, a social scientist, says:"By the nature of the destruction in Ahmedabad, one is led to
believe that there was seme sort of planned organisation! of the riots. Soon after the Jagannath temple
clash,rumours appear to have been systematically spread. By the noon of the 19 September hundreds
of printed and cyclostyled handbills stating that a cow had been killed and the Mahant seriously injured,
that the Muslims had entered the temple and that the idol of god had been damaged were distributed.
There was no truth in any of this. In Baroda too rumours were spread about the burning of the
Swaminarayan temple). During the riots, handbills giving false, exaggerated and provocative news
published. They instigated Hindus to take action against Muslims. One of the handbills appealed to
Hindus, "Hindus get organised, be bold. Take(weapons in your hands and attack the Muslims who are
out to destroy Hindu religion and Hindu temples. So every Hindu to save his religion, caste, sisters and
daughters must awaken and learn how to attack and learn the policy of defence not cowardice."
I
And throwing light on the role of the media, Ghanshyam Shah savs, "An objective analysis
would clearly indicate that the reporters, being Hindu, were partial in reproducing the news. Whenever
a temple was attacked, the news item read was, 'a temple was attacked' , whereas when a mosque
was attacked it read as ' a religious place was attacked'. The whole policy of spacing and display was
biased. Newspapers gave headlines to rumoured reports of attacks on Hindu temples. For instance, a
newspaper told its readers in the headlines that the Gita Mandir temple had been attacked on the 20th.
The report was entirely false. In fact, by the 20th (September) the Hindus were in complete control of
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this area. Similarly, reports on the Jagannath temple were confusing 1o readers, and provocative."
(Ghanshyam Shah "The 1969 Communal Riots in Ahmedabad. A Case Study" in Asghar Ali Engineer
ed. op.cit)
Bhiwandi, Jaigaon Riots_______
w
The Ahmedabad not was followed by another major riot in Bhivandi-Jalgaon in 1970. Its cause was
also mainly political. The main instigator of (Bhivandi-Jalgaon riots was the then newly formed
Shiv-Sena. In fact this organisation was formed only in 1968 and some congress leaders were
allegedly behind it. Mr. Bal Thackeray was both strongly against South Indians on one hand, and,
Muslims, on the other. His and his followers anti-Muslim demagoguery created communal tension. The
Bhivandi riots broke out in May, 1970 on the eve of Shiv Jayanti. In this riots too the role of the police 7
was quite partial and came for strong criticism by Justice Madon in his inquiry committee report known
as Justice Madon Commission Report. In one (incident a police sub-inspector in Jaigaon led a mob
which set fire to the house of a Muslim widow Hajrabi in which her children were burnt alive. Also, in
Jaigaon a marriage party comprising 40 persons - all belonging to minority community - were burnt
aiive. About 250 people died in these riots in Bhivandi-Jalgaon. The role of Marathi press was quite
partial. It mainly blamed Muslims for starting the riot. The Police also framed some Muslim leaders for
,
planning the riots. The police also came for severe criticism for killing many innocent people. In this
;
riot large number of isolated Muslim families in villages were killed and their bodies thrown into wells or n ■ <<
nearby nullahs. The role of the police came in for severe criticism in the Madon Commission Report
which was appointed to inquire into the Bhivandi-Jalgaon riots of 1970 specially for involving innocent
Muslims in the conspiracy to plan communal riots and leaving out the real culprits.
1970s : Al! Quiet on the Communai Front
I
There were no communal riots on large scale between 1971 and 1977 as the political situation did not
warrant. The Bangla Desh liberation struggle started in late 1970 and continued until it was liberated in
1971 and the whole country was preoccupied with it. After liberation Jay Prakash Narayan started a
movement against corruption. It was mainly directed against Mrs. Gandhi. It culminated in declaration
of emergency in 1975 when Mrs. Gandhi was unseated in an election petition by the Allahabad High
Court. And in emergency most of the opposition leaders and party workers including those of Jan
Sangh, RSS and Jamat-e-lslami were arrested and put behind bars. Thus while the country was
pre-occupied with the anti-corruption movement led by Jay Prakash Narayan from 1972-1975, there
was total vacuum from 1975 to 1977 (wheri emergency was lifted) as all important leaders of
communal organisations were in jail. Thus there|were no riots during 1971-77.
Elections took place in 1977 when tpe Congress led by Mrs. Gandhi faced crushing defeat
and the Janata Party was elected with overwhelming majority. Janata Party was amalgam of
ex-Congressmen, Socialists and Jan Sangh. It ^vas precisely for this reason that the J.P. Government
did not last long and fell through in 1979 due to sharp internal contradictions. The Socialists demanded
that the Jan Sangh leaders resign from the RSS as duel membership could not be entertained. The
RSS was not prepared to allow the Jan Sangh members to be unleashed from its ideological bond.
When the controversy was going on and the Janta party Government was still in power
some majo* riots took place in Jamshedpur, Aligarh and Benaras. There is clear evidence that the RSS
had hand in Aligarh and Jamshedpur riots. Its local leaders Shri Nauman (in Aligarh) and Shri Pande
(in Jamshedpur) were behind these riots. Wlpile the Aligarh Riot took place on the question of
ownership of a piece of land, the Jamshedpur riot took place on the question of route of a Hindu
• religious procession; All these riots were well planned in advance and the role of police in these riots,
9
specially the PAC (Provincial Armed Constabulary) of U.P. and BMP (Bihar Military Police) of Bihar
was far from desirable. There were open accusations of their involvement with communal elements of
the majority community, specially the RSS and th,e Jan Sangh. In these riots hundreds of people were
killed. In Jamshedpur a van which was carrying women and children belonging to the minority
community was set ablaze and more than 14 persons perished.
1980s : Alienated Minority, Politics ofBJr u„uuic decade of
..
Mrs. Gandhi came back to power in 1980 general elections because of dismal failure of the Janata
Party. However, she was elected with much reduced majority. In 1977 she faced crushing defeat as
both Hnidus and Muslims were alienated from per, specially in the North, due to the emergency
excesses. Muslims were all the more angry as number of them were killed near Turkman Gate when
Muslim kutcha houses were bulldozed to 'beautify’ the area, many children were crushed to powder
under bulldozers. This news spread like wildfire throughout the country and Muslims voted against her
massively.
But she succeeded in partially wooing back a section of Muslims after the Janta Party
Government fell through. However, she could npt win back massive Muslim support. This made her
politically insecure and she began wooing middl^ caste Hindus for her survival in power. At one time
she used to strongly condemn RSS and other Hindu communal outfits in order to win minority support.
However, after her re-election in 1980 elections with reduced majority, her electoral strategy changed
and she became quite soft towards Hindu communalism as she needed mainly the support of the
majority community for her political survival.
(Moradabad Riots 1980)
When a major riot broke out in Moradabad in August 1980, she quietly encouraged a propaganda that
the Moradabad riot was financed by 'petro-dollars' from the Middle-East. Shri Giri Lal Jain, the then
Chief Editor of The Times of India wrote several signed articles in his paper to say that Arab money
was flowing into India to finance riots. Mrs. Gandhi's Government did not contradict this, though there
was no proof ror this allegation. In fact until today no one was able to substantiate this charge.
However, due to such propaganda it was widely believed that the Arab money was financing the riots.
In fact there is evidence to show that to begin with it was a clash between the police and the
Muslims in Moradabad on the question of straying of a pig into the Idgah Maidan where Id prayer was
going on. However, it was soon converted into Hindu-Muslim riots by those Hindu business elements
(mainly Punjabis) who were resenting rse of sorpe Muslim artisan families as successful businessmen
exporting their brasswares to Middle Eastern countries. These Muslim artisans turned entrepreneurs
became business rivals and had to be eliminated at any cost. The main attack during the riots in
Moradabad was on such Muslim entrepreneurs.;They suffered considerably. Thus the Moradabad ript
had close resemblance to the Jabalpur riot of 1961. But Mrs.Gandhi subtly used the Moradabad riot for
her political purposes.
(Biharsharif Riots 1981)
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It was in 1981 that another major riot took place, in Biharsharif in the Nalanda district of Bihar. The riot
broke out on the question of a cemetery land which had fallen into disuse. In fact in Biharsharif town
the land prices were skyrocketing on account of rapid urbanisation and rich yield of potato crop. The
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Yadavas, a Hindu middle caste, were mainly in the business of growing potatoes. A Yadava cultivator
... was tryir.g to usurp a cemetry land and the dispute broke out between some Muslims and Yadavas.
The RSS became active and spread rumours in the neighbouring villages that Muslims were
massacring Hindus and that they have mixed poison in the main water tank. This created scare and
resulted in much greater massacre. So many people were killed that truckloads of bodies had to be
carried away to morgues. Even Mrs. Gandhi broke down and wept. The role of BMP and the local
police was openly partisan. The administration was totally paralysed and could not even effectively
counter rumours. The Biharsharif riot was, in terms of its impact on the country, quite comparable to
the Jabalpur and Ahmedabad riots of 1961 and 1969.
(Meenakshipuram Riots, 1981)
In fact the decade of eighties was most dangerous decade from communal perspective. Several major
communal riots took place during this decade. And besides that number of communal controversies
preoccupied entire country. It was in the begi ining of this decade that the great c controversy about the
Meenakshipuram conversion took place. In 981, some dalit families converted to Islam (in all about
500 persons) to avenge an insult by the Upper caste Thevars. A dalit boy refused to take off his shirt
and chappal while passing from Thevar locality ass per old custom, the Thevars beat up the boy and
got him arrested on the false charge of theft. This incensed the dalits who converted to Islam to
avenge the incident. It had nothing to do 'with 'petro-dollars' but again a powerful campaign was
launched by the VHP (Vishwa Hindu Parisfad) against conversion as an 'Arab conspiracy' to make
India Islamic. It created strong prejudices against Islam and Muslims in India. There is some evidence
to show that Mrs.Gandhi exploited this controversy to increase her appeal amongst the Hindus. It is
also alleged that she subtly backed up the VHP campaign against conversion. The VHP was set up in
the mid-sixties by the RSS for preaching of Hinduism. It had no political role until 1980. But after the
Meenakshipuram incident it assumed political overtones and played significant role in communalising
the politics. It began to play role in the riots also. The VHP had role in the Meerut riots of 1982. It
played role in several riots subsequently and became a premier organisation for spreading
communalism and communal violence during the eighties.
In 1982 two major riots took place one in Meerut and other in Baroda. The Meerut riot was
again caused by a dispute over a piece of Land in Shahnathan locality. But it was the apparent cause.
The real cause was political. The BJP (The Jan Sangh was renamed as the Bhartiya Janata Party after
it separated from the Janata party in 1980) was trying to capture power in the Meerut Municipal
Corporation elections which were due. The BJP, in collaboration with some disgruntled Congress
elements, used this controversy involving a local saint's mausoleum at Shahnathan to incite Hindu
communal passions. In this riot too the polide played highly partisan role, killing several innocent poor
Muslims Even Justice Krishna Iyer, the retired Supreme Court Judge, wrote a letter to Mrs. Gandhi
highlighting the atrocities of the police on innocent people and how many were brutally killed. The letter
was also published by The Mainstream a weekly from Delhi.
(Baroda Riots,)
—
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i he Baroda riot was sparked by the bootlegging mafias of Baroda, it was a result of rivalry between
two mafia gangs one led by one Shiva Kahar and another by a Muslim. They used religious symbols
like Shivaji's Bhavani Talwar (sword) and Tazias to capture monopoly of illicit liquor business. Thus
two criminal mafia gangs could incite copimunal violence on a large scale, this was particularly
possible because of criminalisation of politics. Both the criminals had links with powerful political
bosses as well as with the police. Shiva Kahar, who headed the 'Hindu' gang had connection with the
president of Baroda.Congress Committee president Bhogilal Patel. A police inspector had direct links
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with Shiva Kahar. Baroda witnessed severa riots because of criminalisation of politics. The BJP also
had developed close relationship with some of these mafia leaders. Baroda had become communally
most sensitive until these criminals were eliminated in the so called 'police encounters'.
(Assam Riots, 1983)
The year 1983 witnessed horror of Ne ii riots Neili is in Assam and in this area many Bengali Muslims
live. According to them they have been living there since nineteen forties. However, they were branded
as recent migrants from Bangla Desh and became targets of the fury of the AASU movement. In fact
AASU by itself was not a communal organisation but over a period of time it was infiltrated by the RSS.
It is interesting to note that in Assam trade is mainly in the hands of Marwaris of Rajasthan. These
traders are generally supporters of RSS apd BJP and particularly in Assam as they are seen as
outsiders there. They also financed AASU ip a big way and hence influenced its policies. More than
3000 persons, mainly the Bengali speaking Muslims, were killed in these riots. In Neili too a powerful
machinery spread rumours that the Bangla peshi Muslims raped Hindu women and cut their breasts
and hung them over swords. This rumour spread like wildfire and did all the damage. Thus a regional
movement was turned into a communal movement. It spread terror both among Bengali as well as
Assamese Muslims. In fact on the question of Assamese identity, the Assamese Muslims were
supporters of the AASU movement. But their enthusiasm cooled after the Neili incident.
(Delhi Riots, 1984)
Delhi witnessed anti-Sikh riots in 1984. Mrs. Gandhi was assassinated on 1st November, 1984 by her
Sikh body guards. The Congress leaders organised hordes from various slums (Jhonpdi Jhuggis) on
the fringes of Delhi to massacre Sikhs. The field investigations indicated role of some of the top
Congress leaders from Delhi in organising the massacre of the Delhi Sikhs. It is estimated that about
4000 Sikhs were killed in Delhi and many more in other towns of U P. Some were killed even as far
away as Tamil Nadu. The anti-Sikh riots were mainly organised to avenge Mrs. Gandhi's assassination.
However, unlike the Hindu-Muslim riots the RSS and BJP had no role in these riots, it was mainly the
Congress which was involved. The RSS and BJP treat the Sikh minority on a different footing. Despite
the Khalistani movement's anti-Hindu propaganda, the Saffron Brigade tried to maintain cordial
relations with the Sikhs - treating them as allies rather than as enemies. According to Golwalkar only
the Christians and Muslims are foreigners and their sympathies lie with other countries. The Sikhs and
Buddhists are Indians and offshoots of Hinduism and hence they need friendly treatment.
I
Bombay, Bhiwandi Riots, 1984
I
Bombay-Bhivandi were rocked by communal violence in May 1934. The Shiv Sena had lost much of
its regional chauvinistic appeal and was sulking and was in searcri of some issue to revive the morale
of its cadre. In early eighties, as pointed out before, Hidutva forces led by the Sangh Parivar, were
getting more and more aggressive. The Sepa leader Bal Thackeray jumped on the band wagon and
organised a Virat Hindu Sammelan on the sands of Chowpati, Bombay in Bombay in the third week of
May, 1984. he poured out venom against Muslims and spoke derogatively of the Prophet. It provoked
Muslims and some garlanded the portrait of Bal Thackeray with garland of shoes. The violence started
from Bhivandi and engulfed entire region from Bhivandi to Thane to Bombay. The Shiv Sainiks were
on rampage throughout the region. Forty persons were burnt alive at Ansari Baugh, near Bhivandi.
Mr.Vasant Dada Patil was he chief minister, in order to fight against the faction in the Congress against
him, he made a deal with the Sena Chief and allowed him a long rope. Thus even under the leadership
of an upright police officer like Rebeiro, communal violence could not be easily controlled. However,
when the riots were.to break out again in the second phase, Rebeiro sent out a circular to all police
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stations in Bombay that if violence broke out in their area the police officers at the police station will be
held responsible and suspended. The police Jarrested all goondas and many Sena Pramukhs and
nothing happened. It shows if the police follows the proper strategy, riots can be prevented with
minimum damage to life and property. More than four hundred' persons were killed'in the
Bhivandi-Bombay riots.
Riots in Gujarat, 1985
The locale of the riot shifted again to Gujrat in 1985. Madhav Singh Solanki contested and won the
Gujrat Assembly elections with big majority by announcing reservations for the backward classes
recommended by the Bakhshi Commission appointed by the Gujrat Government. Solanki used what
was called the KHAM formula (i.e. Kashtriya, Harijans, Adivasis and Muslims). He sought support of
these sections of society by offering them reservations in government jobs.
The Patels, the most influential people ffpm Gujrat were unhappy as they were left out in this
bargain. They launched a movement against reservation to weaken the Solanki Government. When
the movement got momentum and threatened stability, Solanki shrewdly, having won the elections
anyway, suspended reservations. However, the opposition, determined to overthrow Solanki, gave
communal turn to the movement by starting communal violence which broke out at 7 pm on 18th
February, 1985.
The communal violence continued in Ahmedabad until the Solanki Government was
removed by Rajiv Gandhi in October, 1986. Thus the communal violence continued in Ahmedabad for
20 months. The main objective was to remove Solanki and violence continued to be engineered until
the political objective was achieved. The bqilder's lobby also played a great part by engineering
communal violence to terrify people into selling their properties cheap and running away to safe
havens. To cheque communal violence engineered by such interests the Gujrat Government had to
issue an ordinance called prevention of distress sale of properties ordinance not registering sale of
such properties, that finally brought communal violence under cheque. Thus in Ahmedabad riots of
1985-86 both economic and political factors together played important role.
From 1985 onwards certain developments further brought about deterioration in the
communal situation. The Muslims were feeling terribly insecure because of repeated communal
violence and reacted aggressively against the Supreme court judgement in case of a Muslim divorcee
- Shah Bcino - succeeded in getting maintenance under section 125 of Cr.P.C. They considered it as an
interference in the 'divine law' i.e. the Shari’alj which permitted maintenance only for a period of iddah
(three months after divorce). Lakhs of Muslims poured out on the streets to protest against the
judgemert and finally forced the Rajiv Gandhj Government to overturn the Judgement by passing the
Muslim Women's Act in early 1986. This was bowing down before the Muslim fundamentalists and
weakening the secular forces. This Act was -a tremendous blow to secularism. It also strengthened
Hindu communalism and made it more aggressive. The Rajiv Gandhi Government also traded off with
the Hindu fundamentalists by agreeing to open the lock of the Babri Masjid.
Thus the Rajiv Gandhi Government surrendered both b before the Muslim as well as the
Hindu fundamentalists and delivered a body blow to secular forces. Despite trying to please
fundamentalists of both the communities, he lost elections in 1989 and was assassinated by LTTE
terrorists while campaigning in the second phase of 1989 Lok Sabha elections. V.P.Singh and
communists too, in their anti-Congressism, made seat adjustments with the BJP thus enabling it to win
89 seats in the Lok Sabha as against two it had won in 1984. The Ramjanambhoomi-Babri masjid
controversy begun by unlocking of the mosque also greatly helped the BJP. The Ramjananmbhoomi
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movement greatly boosted the Hindu fundamentalist forces and the communal situation worsened
beyond description.
Ayodhya Chapter
The BJP was now determined to draw as much political mileage as possible by stirring the Hindu
religious sentiments. The entire Sangh Parivar which included, besides BJP, the VHP, the RSS and
the Bajrang Dal threw itself into the Ramjanambhoomi movement with all their energies. The Bajrang
Dal mostly consisted of lumpen elements and drew upon the unemployed youth. The BJP thought it
was a golden opportunity for it to capture power at the Centre which otherwise it couid never dream of.
It was as a result of this aggressive Ramjanambhoomi movement that the Meerut riots of 1987 and the
Bhagalpur riots of 1989 took place.
Meerul
Both these riots shook the entire country. Though initially the Muslims in Meerut showed aggression
and started riots but soon they became its main victims and paid dearly with their lives and properties.
The Meerut riot was another dark chapter [in th history of communal violence in post-independence
India. More than 400 persons lost their lives and 24 young boys from Hashimpura were pulled out by
the PAC jawans, shot dead and their de^d bodies thrown into nearby canal. Fortunately two boys
survived miraculously to tell the story. Similarly, about 67 persons were shot dead in Malyana near
Meerut when police fired on the unarmed m.ob after the Friday prayer. All bodies were buried in a mass
grave. The police in Meerut behaved open y as a Hindu police. Yet no action was taken against it by
the authorities. The PAC killed 24 young men pulling them out of their houses ancteven FIR against
the commandant and other PAC men guilty of killing was filed only in 1995, some eight years after the
incident. And no one knows what happened after filing FIR.
Bhagalpur
z :
The Bhagalpur riots of 1989 were even worse. About 1000 people were killed. In many cases the police
led the mobs and killed innocent people. In one village near Bhagalpur several people were killed in
presence of a sub-inspector and their bodies thrown into a well. When they began to stink, the police
officer buried them in a field and grew vegetables over it. It was a villager whose conscience could not
bear it and he reported the case to the authorities and the bodies were dug out. In case of Bhagalpur
several villages on the periphery were affepted. Much killings took place in these villages. In Bhagalpur
riot too the rumour was spread that several Hindu students were killed by the Muslims and their bodies
thrown into nearby wells. It was completely a baseless rumour. Many innocent people were killed
because of this rumour.
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1990s ; Establishing Communalism, BJP on the Wings of Ram
I
On 8th August 1990, the V.P.Singh {Government, announced implementation of the Mandal
Commission Report. The BJP feared that it would split the Hindu votes which it was trying to
consolidate. To avert this possibility, the B^JP President Shri L.K.Advani announced Rath Yatra on 23rd
August. His Yatra started from Somnath( in Gujrat and was to reach Ayodhya via a complex rout.
Number of bloody riots broke out when the Yatra was on. It was rightly described by the Times of India
editorially as "blood yatra".The communal atmosphere was surcharged in the country at the end of
eighties because of the BJP campaign for Ramjanambhoomi. Riots could break out anywhere on any
excuse. Never after the partition the political atmosphere was so highly commurratised in India. In late
forties it was'Muslim communalism which was at its aggressive best and towards the end of eighties it
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brink. This hate
was Hindu communalism which had reached its nadir and the country was on the bnnk.
campaign ultimately resulted in the demolition of Babri Masjid on 6th December 1992. And the ne^t
day in Bombay, Surat, Kanpur and Delhi pommunal violence burst out on a large scale. What
happened in these places was the worst example of human savagery. In Bombay alone more than 800
people were killed during December, 1992 and January, 1993 riots. In Surat several women were mass
raped in search light and paraded naked. The'death toll in Surat was more than 300. In Bombay police
role was openly partisan. Many policemen sided with Shiv Sena mobs and abused Muslims One
police officer in Govandi area went berserk and killed several Muslims. He had to be transferred by
senior police officer.
I
DISASTER MANAGEMENT AND COMMUNAL VIOLENCE
From Description of several riots above it is clear that:
1) Major communal riots cannot take place without creating highly communalised atmosphere;
2) No major communal riot can take place without planning by an interested political party;
3) Communally surcharged atmosphere is oftpn the result of political competition between secular and
communal parties for votes of majority and minority communities. In other words the politics of
vote-banks play an important role in engineering communal violence;
4) the riots get aggravated by the partisan role of police and complete breakdown of law and order
machinery;
5) rumours play very important role in spreading violence
6) any expression of minority communalism results in aggravation of majority communalism;
7) The Ramjanambhoomi movement could succeed largely because of distorted understanding of
history;
8) the district administration is often confused and has no clear direction after outbreak of communal
violence;
|
9) and secular forces take backseat, even get paralysed when large scale communal violence breaks
out and political atmosphere is surcharged,with communalism as is clearly shown by several riots
specially the Bombay riots of December-January 1992-93.
The real question is what is to be done to pheck communalism and communal violence. There are
measures which can be taken. Some of these measures are short term and some long term. We will
throw light on both. Among the short term [measures following things could be done:a) The police
should be fully held responsible for control ofj communal violence. If it fails to check violence within 24
hours of its outbreak, the concerned officer should be transferred or suspended depending on the
gravity of the situation.
'
b) The police should be properly trained in riot control measures and should not be encouraged to fire
at slightest provocation which it often does resulting in loss of lives. In some of the recent riots
specially the Bombay riots of December, ;1992, more people were killed in police firing than in
stabbing. In December 1992 about 200 persons were killed in police firing alone. The authorities should
make water hoses and rubber bullets available to the police for controlling riots without loss of life. The
police authorities complain that despite several requests government has failed to make water hoses
and rubber-bullets available. It is serious complain and the authorities should loose no time in doing so. >.
Also, such policemen are sent to control riots who have had no gun firing and target practice for
several years. When they fire they often miss their target and innocent persons get killed. Such
persons should not be entrusted with riot control job. But the police force is often inadequate and
untrained cops are rushed to control the situation.
15
There are no proper guide lines to the administration and when communal violence breaks out the
•administration gets confused. Proper guide-lines should be issued and riot-control measures should be
enlisted. The West Bengal Government has done it and as a result for a long time no major communal
violence has broken out there except after lemolition of Babri Masjid. But these riots were also
If chief ministers take personal charge and direct operations with the help
speedily controlled.
of trusted officers even the grave situation can be brought under speedy control as is shown by Laloo
Prasad Yadav’s assuming personal charge in Sitamarhi after district administration faiied to control
violence. He not only motivated the officers concerned, he also handled the situation politically with
the help of local leaders. Jyoti Basu's assumi ig personal charge after outbreak of major violence in
Calcutta after demolition of Babri Masjid. The Riots in Bombay could not be controlled in
December-January 1992-93 precisely because the Chief Minister Sudhakar Rao Naik had no political
will to do so and partly he was paralysed by faction fight within the then ruling party. He remained
totally inactive. Even Prime Minister Narsimhe Rao showed no willingness to control riots and visited
Bombay only after all the damage had been done and riots had stopped.
c) The notorious goondas should be speedily arrested and those who provoke riots should be put
behind bars and violence will be prevented as is shown by the second phase of communal violence in
May, 1985 in Bombay. The Police Commissioner Rebeiro sent out circular to this effect to all the police
station and the job was done.d) Effective measures should be taken to check spread of rumours. Much
greater damage is done by baseless rumoury. For example, in Meerut 1987 riots the rumour was
systematically spread in both the communities that four Hindu/Muslim girls were raped and their
breasts cut off and their dead bodies thrown into the street. Most of the people took this rumour very
seriously and administration took hardly any measure to check it. My experience of investigating
various major riots show that riots can be easily controlled if these rumours are effectively checked. In
Bhivandi which was highly sensitive communally no violence occurred because the local police had
evolved proper machinery to check rumours’d) Intelligence machinery should be spruced up and
competent officers should be appointed to gather intelligence. Generally incompetent and unwanted
officers are sent to intelligence department and often their failure to gather sensitive information in
time results in disastrous situation. In Bhivandi'riots in 1970 all concerned agreed that it was complete
failure of intelligence machinery. Same thing was true of Biharsharif riot of 1981. It is also important
that secular officers be appointed to gather, intelligence. Officers with communal outlook gather
information with bias as is clearly shown by Bhivandi riots of 1970. The Madon Commission has also
criticised the role of intelligence officers on this ground. It often happens that the intelligence officers
with communal bias ignore what is going on by’way of communal conspiracy in a particular community
and supply information about another commuqity even if defensive measures are being planned by a
section of that community. This has naturally very serious consequences for prevention of communal
violence.
•
Among the long term measures following sjeps are necessary:
a) Giving training to policemen at different levels from top to bottom. Our Centre for Study of Society
and Secularism has conducted more than fifty workshops for the Bombay police and for the police
officials in Thane, Nashik, Aurangabad, Bangalore, Mysore etc. The subjects covered in these
workshops are:
1)Medieval history and communalism;
' British rule and communalism;
2)
3) Freedom Struggle, communal division and causes of partition;
/Post-independence period and re-emergency of communalism
4)
and 5) analysis of major communal riots after independence.
I
It has been observed that such workshops have very good impact on understanding of the
police and their outlook greatly changes. They respond very positively during discussions. They
I
¥
f
TV.\a < A
,■
I
I
15
-
16
invariably express the feeling that they were mis-informed about these Issues and they express their
interest in knowing more. The communal propaganda infects their minds and supply of correct
information in workshops and training course^ help change their attitude. It shows there is great deal of
need for proper seculai orientation of police force. Suclr workshops are alt the more necessary for the
constabulary and lower-level officials. The case for such re-orientation cannot be stressed more.
Unfortunately such re-orientation courses are- generally not held.
'
The Bombay police which was highly infected by communal virus due to aggressive communal
propaganda greatly benefited by such workshops.b) The police force should be fairly representative* of
minority communities and dalits. Generally it is observed that minority communities do not find
adequate representation in the state police ^nd it is much more true of para-military forces like PAC,
SRP, BMP etc. which are called upon to handle riot situations. There must be strict screening of the
recruits for their secular outlook, it is highly necessary for effective riot-prevention measures. The
Central Government has set up Rapid Action Force (RAF) which has 25% representation of minority
communities and of SCs and STs. RAF has proved quite effective in controlling-riots in several places.
CRPF (Central Reserve Police Force) also has proved its effectiveness as a neutral force in many
riots. It will be much betterrf^FrepiauVb
least.in.the.Hindu-Muslim riots since
these forces have been greatly infected by communal virus. Or else, these forces should be subject to
more rigorous re-orientation courses.
\
c) In all communally sensitive eTGao
should be set up on the pattern of
Bhivandi Mohallah Committees. These comnjiittees can prove quite effective in preventing outbreak of
communal violence by constant vigilance and preventing rumours. Ordinary citizens from the locality
should be inducted in these committees to be presided over by the officer of the police station of the
area. As pointed out before, the Mohalla Committees and dedicated police officers saved Bhivandi
from erupting after demolition of Babri Masjid. This pattern should be followed by all communally
sensitive areas.
d) It is highly necessary to have a rational transfer policy for the top police officials. Many secular
police officials also become non-effective because of such transfer policy. As per the recommendation
of the National Police Commission top police officials should be transferred only by a committee
comprising chief minister, speaker of the assembly and opposition leader. This will remove fear from
the minds of honest an secular police officers. However, though this recommendation was made
several /ears ago, it has still not been implemented. It is high time it is done.
e) It has also been observed that history text books in schools has played important role in injecting
communal poison in the minds of young students which subsequently determines the mind-set of
peop.e when they grow into full-fledged citizens. The Ramjanambhoomi movement wouid not have
been so disastrously effective had such history text books not been taught in schools. It is taken for
granted in these text books that the Muslim rulers systematically demolished Hindu temples and
oppressed and humiliated them and converged them forcibly to Islam. The NCERT survey of the text
books on history has established this beyond any ken of doubt. It is high time such text books are
replaced without any delay. It is highly regrettable that such distorted history is being taught even 50
years after independence. Conducting workshops on medieval history by the Centre for Study of
Society and Secularism and Khoj, both Borqbay based organisations has clearly shown that one of the
most effective ways of fighting communalism is to teach history objectively and scientifically. It has
great impact on the.minds of people. It is also necessary that school and college history teachers be
trained properly.
Similar training is also necessary for the, media people. As pointed out earlier the vernacular press
plays very damaging role in promoting communal tensions and even provoking violence as Bombay
16
!
17
riots of 192-1993 clearly show. During kar Seva in October 1990 also, some Hindi Papers from U.P.
played very provocative role, the Press Councij in its report strongly condemned these papers for their
damaging role. It is much more probable when the papers is individually owned. The case of Gujrat
Samachar from Ahmedabad is illustrative of this fact. It played’quite negative rote during the
communal riots in Ahmedabad during 1985-861 as its owner was hostile to the chief , minister Solanki.
He was interested in overthrowing his Government. These vernacular papers often publish rumours as
news on their front pages doing great damage to the situation. Some papers in Ahmedabad riots of
1969 and Meerut riots of 1987 precisely did this and inflamed the situation. The police often does not
take any action against such papers. If effective legal action is taken these papers will be discouraged
from playing such a disastrous role.
f) It is also necessary to stress that communal propaganda during election campaign does great
damage to communal situation. At times communal violence is planned mainly to win elections by
communal parties. If the Election Commission monitors election propaganda as Mr.Seshan, as Chief
ctedriuri
d.’.'l
be of areat help to check communal violence, if Election
Commission had applied Peoples's Represen ation Act strictly right from beginning, many communal
riots could have been avoided.
•
• ••
g) Most of the culprits taking part in communal violence often go unpunished, thanks to the lax attitude
of police and administration. The Governmept should see to it that the police prepares water tight
cases against those who participated in the riots. Unfortunately when the Shiv Sena-BJP Government
came to power it withdrew hundreds of cases'against the accused in the Bombay riots of 1992-93. As
pointed out above the PAC officials responsible for killing 24 youths from Hashimpura in Meerut have
still not been punished. In case of anti-Sikh riots of 1984 some of the accused are being put on trial
now in 1996-97. Unless the culprits are brought to book further riots cannot be prevented. Also,-those
-killed their nearest relatives 'rite -wife,
etc. should. be adequately compensated. The
compensation should be at least Rs.3 lakhs at the current prices. The compensation amount should be
revised as per price index.
[
The measures suggested above can greatly help in checking communal violence.
/A c
c
8
Pages 17 - 31 Annex I:
cal Tabulation of Instances of Communal Violence in Ir
•
ia
*
Place
Year
1950, 24th Jan
West
Bengal,
Assam
Event
Rumours of a lleged ill treatment
of Hindus in East Bengal.
Communal disorders breakout in
a number oft districts of WB.
Barpeta and Qoalpara districts Qf
Assam affectqd. 40 killed. Over
250 injured. 1500 arrested.
1961,4th feb
Jabalpur,
MP
Rumour of H^ndu girl assaulted,
slain by Muslim youth. Riots
breakout in Jpbalpur. 35 killed,
158 injured, 1003 arrested.
1962,
March
22nd
Maida,
WB
Santhals armed with bows attack
Muslim villace- in Maida. '14
Muslims killed I Burnt and Shot.
64 injured.
1964, 3rd Jan
Calcutta,
WB,
South
Bihar,
West
Orissa,
East MP
Theft of relip from Hazratbal
shrine
in
-•
- 20,000
Srinagar.*
demonstrators
riot
in
East
Pakistan districts of Khulna and
Jessore. Hindi) refugees flee into
WB. Riots break out in Calcutta
and Suburbs. 208 killed in mob
I
violence, 56 in Polfce Actipn.
Trainload of refugees pass thru,
and riots breajkout in Southern
Bihar, Western Orissa and
Eastern MP. j 346 killed, 458
injured, 4 lakh worth property
destroyed.
1965, 19th July
Rajasthan
Minor Scuffle between Hindu and
Muslim neighbours. Riots break
out in Uciaipur.i 2 killed in police
firing. 12 injured. 65 shops
looted, property worth Rs.12
lakhs destroyed.
1966, 13th Nov
Rajasthan
Dispute between two people.
Communal riots in Udaipur. 1
killed in police firing. 86 Bohra
Muslim shopslooted.
1967
Calcutta,
WB
Conflict between Hindu and Sikhs
over temple eqtry thru shrine? 11
killed. 100 injured.
1967,
August
24-28th
Srinagar
Brahman girl’s conversion 'to
islam and marriage to a muslim.
18
I
1
19
1967,
August
24-27th
Ranchi,
Bihar
1968,28th Jan
Maharash
tra
UP
1968, 2nd Mar
Assam '
1967, 25th Sep
Conflict between Pandits and
Muslims. 3 killed. 162 injured.
Urdu declared second official
language of pihar. Violent riots in
Ranchi. 150 killed, over 100
injured; 100Q arrested.
4 killed in riots in Malegaon.
Hindus attack Muslim'’ political
meeting in Meerut. 17 killed.
Communal riots‘in Karimganj. 7
killed, 43 injured, 233 arrested.
1968, 4th Mar'
WB
Dispute between two people.
Communal idiots in Calcutta. 3
killed, 9 injured, 900 arrested.
1968, 15th Mar
UP
Riots following Holi celebrations
in Allahabad.' Muslim shops and
houses looted, set on fire. 3
killed.
1968, 30th Mar
Assam
Rumour of cow slaughter. Riots in
Tinsukhia. 40 injured, 3 houses
burnt down.
1968, 8th June
Maharash
tra
Rumour of ^cow slaughter by
Muslim baker. 3 killed, bakery
looted in Aurangabad.
1968,
June
10-14th
Maharash
tra
Arguement between barber and
customer. Riots in Nagpur . £9
killed. 3 killed in police firing.
Cinema hall and 150 houses
burnt.
1969, 18th Sep
Gujarat
Dispute between Sadhus and
Muslim youth, in Jamalpur. Major
riots breakout in Ahmedabad.
Over
1000;
killed,
several
hundred musljms fled to villages,
15000 muslim seek shelter in
relief camps.' 3969 houses apd
shops
burnt
and
2317
destroyed.
6000
families
destitute, crores worth property
destroyed, real income loss upto
33.7 crores. !
1970, 7th May
Maharash
tra
I
Riots in Bhiwandi followipg
procession on; the birth of Shivaji.
82
killed, j 1000
house^
destroyed, f^iot
spreads to
Jalgaon. 48 killed. 19 Muslim^
burnt alive, riots breakout in
Thana and Kalyan. Police fire pn
19
20
mob. 14 killed. Majority dead
were muslimp.
1971
UP
1972, 16th June
UP
Demand for AMU to be declared
a
muslim | university.
Riots
breakout in Aligarh
Demonstration against the Aligarh
Muslim
University Act.
Armed
clashes between hindus and
Muslims
in
benaras
and
Ferozabad. Arson and Lootipg .
23 killed.
1973, 10th Dec
UP
between
arguement
An
customer.
Shopkeeper
and
communal qots break out in
Meerut. 9 killed, 40 injured, 600
arrested.
1974, 5th May
Delhi
Dispute between a Hindu and
Muslim. Armed mobs fought for §
hours. Communal liot in Delhi. 10
killed, 300 injured, over 10p
shops and houses damaged by
fire.
1975, 17th April
Andhra
Pradesh
Dispute over right to passage in
front of a temple. Riots in
Muppala village, Guntur district.
10 killed ini police firing. 8
injured.
i
1977, 23rd Oct
UP
Clashes following immersion of
Goddess Durga. Riots in Benaras.
8 killed. 65 injured.
1978, 29th March
UP
Riots following procession in
Moradabad. 15 killed, over 10Q
shops looted, 5 burnt alive by
mob.
1978, 29th July
J&K
Hoisting of Wakf flag in the
djoining the Spn
compound
Temple in Anant nag. Removal of
flag
by authorities.
Protest
Crowd turn
demonstratior
violent, stone police. 4 killed. 30
policemen injured. 50 arrested.
1978,
August
28th
AP
Communal nots in Hyderabad.
Army called out.1 killed. 85
injured. 150 arrested, over 2Q
houses, shops and hotels set
on fire.
1978, 3rd Sep
1978,
MP
5th
UP
Disturbances ^at religious festival
in
|
Chindwara.
Police firing. 1 killed.
Alleged murder of a Hindu |n
:
20
V
21
October
H ndu mobs killed 11
muslims, p undered and set fire
to muslim st ops and houses.
Hindu religious procession stoned
while passing through a mosque.
Aligarh.
1978, 12th oct
AP
2 killed.
1978, 9th Nov
UP
'
Rumours of Hindu killed by a
Muslim. Riots in Aligarh. 16
killed.
1978, 14th Oct
MP
Stampede and riots following a
procession in Indore. 22 reported
killed.
1979, 11th April
Bihar
1979, 17-20 June
UP
1979, 4th July
Bihar
1
Hindu religious procession halted
near a mosque in Jamshedpur.
117 killed. 333 injured, 1215
were arrested, 772 houses pnd
shops burnt down. .
Riots in A igarh. 7 killed. 48
injured.
Riots in 12 villages of Purnea. 30
killed. 100 injured.
1979,
28-29
August
1979, 21 June
Bihar
Communal riots in Jamshedpur.
10 killed. 50( injured.
WB
Communal nots in Nadia district
28 killed. <100 houses in 12
vilages burnt down.
1979, 23rd Nov
AP
in
Communal
violence
Hyderabad. Over 100 injured^
1425 arrested.
FDamage
property worth 5 millFqn.
1980, Feb
Bihar
to
Violent clashes between two
communities 2 injured, 6 shops
burnt.
1980, 13th July
1980,
August
1980,
august
13th
Maharash
tra
Delhi
Riots in Jalgaon. 4 killed jn
police firing,
houses burnt.
58
injured.
2
12 injured in communal clash
in Delhi.
<
13th
UP
1980, August
UP
1980, August
UP
Pig strayed into Idgah in
Moradabad ' during Id prayep
Altercation between congregation
and armed* PAC. Communal
clash. 119 killed , 200 injured
Protest demonstration attacked
police, civilians with knives in
Meerut. 3 injured.
Constable stabbed to death in
Rampur. 4 arrested
21
22
1980, 16th Aug
UP
1980, August
UP
1980,
august
29th
Communal violence in Aligarh. 2
killed in police firing, 5 injured.
UP
1980,
August
15th
UP
1980,
August
15th
MP
I killed apd 50 arrested in
Bareilly. 134 firearms seized.
Riots in Allahabad, I injured, 679
arrested, foreign ammunitipns
recovered.
communal
violence
jn
Moradabad.; Indefinite curfew in
Sambahal town.
Violence in Mau
Communal Vi
following a procession. 3 killed,
34 injured.
1980, August
J&K
Riots, arson and kilting
kilfing jn
j
Srinagar following the Moradabad
incident. 2000 arrested
in
Kashmir valley.
1980, 18th Sep
Karnataka
Communal pots in Devangeqe. I
killed, 3 injured.
1980, 20th Oct
Tamil
nadu
Riots
following
a
religious
procession. 14 injured in police
firing.
1980, 26th Oct
UP
Renewed violence in Moradabad.
I
16 killed, 150 arrested
1980
UP
Riots in Saharanpur on the eve of
Dusshera. 2 killed, sevpral
injured.
1980, 29th Oct
Gujarat
(
Dispute between two cartpullers.
Communal j riots broke out in
Godhra. 6 killed, 30 injured, p0
cabins and shops set on fire.
schools and mosque damage^.
1980, 10th Nov
Orissa
1981,29th Mar
Gujarat
Riots
in | Cuttack
following
immersion procession, 6 shop^
damaged by mobs.
Ghanchi
Clashes
between
muslims and Sindhis in Godhara.
Riots in March, June and August.
2 killed, 23 arrested.
1981, 3Cth April
Bihar
Dispute over Cemetery laqd
between Yahavas and Muslims in
Biharsharief . Riots breakout.
Over 150 killed, 60 injured, 12
houses burnt by mob, 50Q
arrested. |
1981, 11th May
UP
Dispute between two people.
Riots in luckhnow. Rioters stoned
and looted shops. 34 injured, 25
arrested.
22
23
1981, 13th June
Gujarat
Mob violence over alleged
removal of religious material from
place of worship in Dhoraji town.
1 killed, 8 injured.
1981, 22ndjune
Gujarat
1981, 12th July
AP
1981, 1st August
Gujarat
1981,
August
Gujarat
24th
Mob violence and clash in
Vejalpur town,. Shops looted and
set on fire 100 arrested.
Following rumours of alleged
mass conversion of Harijans to
Islam, Hindu religious processipn
played music outside mosque.
Riots in Hyderabad. 22 killed.
250 injured in stabbing, 1300
arrested.
Communal riots in Godhra. 3
killed, 11 injured, 18 arrested.
clash
following
Communal
Janmashtami
celebrations
in
AhmedabadJ 110 arrested. 10
shops burnt
1981,
25th
August
1981, 13th Sep
UP
Gujarat
Explosive thrown at religious
congregation jin Moradabad.
Dirty water poured on Ganesh
immersion procession in Baroda.
Riots break out. 5 killed, 30
injured.
1981, 3rd Oct
Rajasthan
Dispute over cemetery land in
Chomu town. 3 injured by
gunfire, 28 arrested.
1982, 10th Jan
Gujarat
Disputes between two groups on
kite flying issue in Ahmedabad.
VHP propaganda about Harijans
being converted to Islam. 1
killed, 7 injured.
1982,30th sep
UP
Temple-Mazar controversy in
Meerut. RSp chief visits town.
Attempt to woo Harijan votes by
BJP. Riot break out. 100 killed,
90 muslims and 10 Hindus' 42
killed
by
PAC
bullets.
Weapons, I Ammunition
and
explosives recovered.
1982, 15th Feb
Maharash
tra
VHP
procession
create
disturbances near Punjab Talim
Mosque in ^olapur. 4 injured in
police firing, Shops burnt.
1982, Feb
Maharash
tra
VHP •
procession
create
disturbance in muslim locality ,
damage property in Pune. Muslim
shops stoned, burnt
23
I
I
24
and damaged, loss of property
worth 4 lakhs.
1982,, 22nd Oct
Gujarat
Police attack Tazia procession
following stabbing incident in
Baroda. 7 killed in police firing,
55 injured) 622 arrested, 31
properties set on fire.
1982, 1st May
Punjab
Packets of I bidi and cigarettes
found
in | Kesargarh
Sahib
Gurdwara. Brickbats thrown at
procession Jaken out in protest.
32 injured ip police firing.
1982,
Tamil
Nadu
Mosque built by converted dalits
gutted after] ommunal vilence jn
Meenakship^ram. 1026 killed
(876 muslims), 2000 arrested,
3932 houses burnt, 891 shops
looted, 30q0 looms burnt, 3/
mosques, 7j madrasas, 8 tombs
imam
baras
and 5 Shia
destroyed.
1982, 6th Nov
Bihar
Riots in Sasaram following Ram
Shila Puja Procession. 2 killed, 5
injured.
1982, 21st Oct
Karnataka
People stoned at place of worship
in Bellur. 50 arrested, shops
loted and set on fire, 3 houses
ransacked.'
1982, 22nd Aug
Gujarat
Quarrel ovef gambling in church
in
Ahmedabad.
compound
Pitched battle between two
communities.
Riots in Sankarankoil taluk ,
following the Meenakshipurarn
conversion of dalits to Islam. 9
I
1982, 12th june
Tamil
Nadu
killed, 30 dqlit huts set on fire.
1982, 6th Sept
UP
Dispute over temple and Mazar in
two adjoining buildings in Meerut.
Crackers fired leading to riots. 11
killed, 24 injured.
1982, 10th sept
Karnataka
Demolition of Muslim place of
worship
by
Bangalorp
develcpmen
authority.
Riots
breakout in Bangalore. 1 killed in
police firing.
1983, 9th Mar
J&K
Spiritual leader Baba Ram Dass
fatally stabbed in Rajouri. Riots
break out. 14 injured. Shops
looted.
24
25
1983, 13th May
Karnataka
*
Alleged misbehaviour towards girl
by a boy of another community.
riots break out in Malur town. 5
killed in police firing. 50 injured
in riots, 15 arrested.
1983, 26th June
Maharash
tra
Communal Clash in Malegaon
following bursting of crackers near
place of worship after India’s
victory in world Cup cricket. 3
killed, 3 injured in police firjng,
500 arrested.
1983, 7th Sept
AP
Communal clash in Hyderabad
following stone throwing at a
temple, followed by desecration qf
a mosque, over 70 killed, 150
injured
1983, 9th Sept
AP
riots
Hyderabad
Communal
following a ba idh called in protesf
of the allege 1 desecration of a
mosque. 45 killed, over 15Q
injured. 300 qrrested. shops set
on fire , prop erty worth 2 lakhs
destroyed.
1983, 21st sept
AP
Police firing c n a riting mob that
stoned Ganesh procession in
Anantapur. 2 killed, 14 injured,
property
> vorth
2
lakh
destroyed, shops set on fife.
1983, 25th sept
AP
1983, 16th Oct
Maharash
tra
Communal riots in old city
Hyderabad. 4^ arrested.
Mob stone Dushera procession in
Solapur. Polipe fire to disperse
mob. 7 killed, shops and
houses destroyed.
1983, 17th Oct
Bihar
Mobs
attack ’ Durga
puja
procession in Hazaribagh. £
killed in stone throwing, 100
arrested.
1984,
March
8-14th
Punjab
Violent clashes between hindus
and Sikh ip Amritsar. Sikh
militants open fire from Golden
temple. 4 policemen and 1 child
killed.,
1984, 19th Feb
Haryana
Group of hindus attack an bqm
Sikh shops aqd houses. 9 Sikhs
beaten to death.
1984, 21st Feb
Punjab
Sikhs on motorcycles, armed with
submachine guns raid nearly
villages in gurdaspur district. 9
25
1
26
killed, many injured.
1984, April
Punjab
Demonstrat on in protest of tt]e
murder of President of BJP,
Amritsar br< nch and the Congress
(I) m?mber of rajya sabha. 10
demonstrators and 2 poticemen
1984,12th May
Punjab
killed.
Communal riots in Jullunder
murder
of
the
following
newspaper editor. Disturbances
break out in Jullunder and spread
to Haryana and northern India.
Skilled in violent incidents.
Some Sikh libraries, shops and
buses burnt.
1984,
17-18th
May
Maharash
tra
alleged .derogatory
Following
remarks by the Shiv Sena Leader
about
Prophet
Mohammad,
communal violence broke out In
Bhiwandi. Disturbance spread to
Bombay, Thane, Kalyan. 230
killed. 11 injured in bomb
explosions in Bombay. Over
150 injured in Bhiwandi. 500
huts
set
on
fire
in
I
Bhiwandi.Loss to private and
public property close to 2000
million in Thane and Bhiwandi
district.
I
1984, june
Maharash
tra
1984, 6th July
Delhi
Communal, Violence in Kherwadi
following the arrest of Bal
Thackeray bf Shiv Sena.
Communal violence in Sadar
Bazar after cyclist stabbing
incident. 1 injured in stabbing, 8
arrested.
1984, 9th Sept
AP
1984,10th Sept
MP
Communal violence following a
hindu religious procession in
Hyderabad; 19 killed.
Riots following
a
ganapati
immersion procession in Sendhwa
town. 4 killed in mob violence
and police firing.
1984, 5th Oct
MP
1984, 5thOct
Karnataka
1984, Oct-Nov ”
Delhi
Riots in Nagda town following the
stoning of the Durga immersion
procession 3 kitted.
Widespread violence and arson in
Belgaum j
following
the
desecratiorj of a place of worship.
Riots in seven northern states,
26
27
Delhi and WB following the
assassination of Indira Gandhi.
1277 killed, property loss worth
200 million.
1985, Apr-Ju!
Gujarat
Inter caste and inter communal
violence in Ahmedabad following
an agitation against
Gujarat
State Government's Education
and Employment Policies. 48
killed.
1985,20thJune
Gujarat
•
Communal yiolence following the
celebration of Rath-Yatra and Id
in Ahmedabad. 8 killed, 12
injured.
1986, 28th March
Punjab
1986, 1st Feb
J&K
1986, 14th Feb
Delhi
Sikh militants disguised as police
officers fire1 in park crowd, in
Ludhiana. 1? killed.
District Court rorder permits
Hindus to worship at Muslim
shrine in Ayodhya. State Goymt
falls in J&K. |200 injured.
Riots following Faizabad court
Oder
for j reopening
Ram
Janmabhumj Temple. 1 killed in
police firing, 26 injured,
arrested. 30i vehicles burnt.
1986, 17th Feb
MP
60
Violence in ISehore following the
Faizabad Court order. 6 killed,
over 100 arrested. 3 houses
burnt.
1986, 19th Feb
Punjab
1986, 23rd March
WB ’
Violence in Batala. Members of
Shiv Sena clashed with members
ofAISSF. 6 killed.
Two groups slashed in Calcutta. §
injured, 20 arrested.
1986, 10th May
Maharash
tra
Riots in Na^ik, Nanded, Panvpl
Shivaji
Jayanti
during
Celebrationsj; 11
killed,
80
injured, over 100 arrested.
1986, 20th May
Maharash
tra
Riots break out in Aurangabad
following the hoisting of green
flag on a tree of a temple. £1
injured, 45 arrested, mob set
vehicles afij'e.
1986, 15th June
UP
Following negotiation over setting
up of shops near shrine, 30p
strong mob surrounded police
post and pelted stones and bottle?
in Allahabad^ 6 killed, 27 injured,
88
arrested.
explosives,
27
•4
28
ammunitions
recovered.
1986, 9th July
Gujarat
1986, 12th July
Gujarat
and
weapons
Communal
violence
in
Ahmedabad
following
stpne
pelting of rattji yatra. 11 killed.
Communal violence spread to
Baroda and Bharuch following
“Gujarat bandh” called by the
VHP following the stone pelting
incident in Apmedabad. 40 killed,
5 burnt alive, over 250 injured,
6 arrested.
1986, July-Aug
Gujarat
Riots in N^diad, Wadiu town,
Baroda, Ahmedabad. 18 kil|ed,
14 injured in stoning incident.
1986, 24th July
Karnataka
Violence
in
Communal
following
the
Ramnagaram
stoning of temple processiop
while passing through mosque. 4
kined, 15 injured, 8 shops set
on fire.
1986, 26th July
Delhi
Riots in delhi following the
gunning dovjn of passengers ina
bus in Pupjab. 5 killed, *50
injured, 84 arrested.
1986,
August
19th
MP
Curfew imposed in Singoli village
of
Mandsaur
district
after
communal clash. 1 killed |n
police firing).
1986, Aug-sept
Gujarat
Communal yiolence in Baroda. ?
killed.
1986, 25thOct
Punjab
1986, 2nd Nov
J&K
1986,22nd Nov
Maharash
tra
;
Sikhs attack village in North
Amritsar. 8 killed.
clash between two communities in
a local cinema hall in Kishtwar.
mob tiled to et the police sation
on fire.
'
Riots in Mazalgaon, beed district
following religious procession. 1
killed, 4 injured.
1986, 30th Nov
Punjab
1986,
Karnataka
Hindu bus passengers killed near
Tanda in Hoshiarpur by Sil$h
militarts. 24 killed.
Communal pots in Bangalore aqd
Mysore following an article
published in Deccan Herald. 17
killed, 100 injured.
1986,
Bihar
Communal
violence
jn
Sukurhutoo village, Ranchi. 3
28
29
killed.
1987, 4th Jan
Gujarat
Riots in Aimedabad over /dte
flying incide it. 18 injured.
1987, 1st Feb
MP
Riots in Ujjain over religious
processionHsO arrested.
1987, 14th Feb
Gujarat
Riots in Ahmedabad following the
arrest of Abdul Latif. 9 killed, 50
injured, shops, vehicles burnt
and looted.
1987, 9th April
Gujarat
Riots follow ng attack on religioqs
procession in the villages of
Virpur, Nupur and Patiya. 6
killed, 50 injured.
1987, 13th April
Gujarat
1987, 20th April
Gujarat
Riots in 5 villages of Panchmahal
district. 1 injured in police firing.
Curfew imposed in Nadiad anp
Cambay tc^wn following incidents
of arson and communal violence.
50 arreste^.
1987, 26th April
Gujarat
Riots in Shahpur following dispufe
betwe en 2| individuals. 5 killed,
10 injured,16 shops burnt.
1987, April
UP
Communal Clashes in Meerut and
Delhi following the Faizabacj
Court orde^ permitting Hindus to
worstiip in Muslim shrine in
Ayodiya. qver 300 killed. Mainly
Hindu PAC blamed for Muslim
deaths in Meerut. PAC arrested
200 Muslims in Hashimpura,
majority were killed, their
bodies thrown in a canpl.
PAC killed 110 Muslims in
Malyana village.
1987, 18th May
UP
Riots following a bomb blast in
Meerut. 105 killed, 131 injured,
2530 arrested. 33 people burnt
alive. 300|muslims, youth and
middle aged men, were arresed
by the RAC, lined up ne^r
Ganga canal and shot.
1987, 27th May
Old Delhi
Following | riots
in
Meerpt
CommunaJ tension built up in
Delhi. Hotels , shops burnt |n
Churiwalan. Police arrested 250
muslims frpm Chandni Mahal whp
reportedly had nothing to do with
rioting. 1$ killed, 12 in policy
firing.
I
29
t
30
1987, 7th July
Delhi
1987, 6th Sept
Gujarat
1987 8th Sept
Maharash
tra
Communal tension in Delhi
following the return of the shashi
Imam who' had not been allowed
entry into Meerut. 2 killed.
Riots in ,South Gujarat during
Ganesh immersion procession.
Riots in Ahmednagar following
at
Ganesh
stone
throwing
immersion procession. 2 killed in
I
police firing. 60 injured.
1988, 23rd July
14th
1988,
September
J&K
Karnataka
Riots in Suratkot and Mendhar.
Mobs loot shop belonging to. two
communities.
Armed ^ikh students attack
Ganesh Pandal in Bidar. 6 killed,
60 injured, 126 arrested, loss of
property worth 5.2 million.
1988, 8th Oct
UP
Riots in *Aligarh following the
attempt by Hindus to display a
banner renaming Aligarh to
uHarigarh”i and the subsequent
rejoinder also in the form of a
banner by'the muslims. 5 killed,
28 injured, 6 shops burnt.
1988,
OCT
8-11th
UP
Bandh cajld by Shiv Sena in
Mujaffarpi^r. Muslims forced to
close down their shops. During
Curfew 'hours
the
Peace
out
a
Committee
takes
MusLm
procession.
Only
Processionists beaten up by
Hindu mob. Riots break out.- 87
killed. 1 injured, 2 arrested, 45
Muslim shops burnt.
1988, Oct
UP
Emerging ! out of the Ram
JanmabhumiBabri
Masjid
controversy, Hindus call for bandh
in Khatauli and force muslims. to
close down their shops. Muslims
retaliate. Riots break out. 2 killed,
10 injured, 7 arrested.
1988, 14-22 Oct
UP
1988, 21st Oct
UP
Communal
Riots
in
Mujaffamagar, 22 killed.
Communal riots- following a
processionj through Wazirganj
area in Faizabad. 1 killed, 12
injured.
1988, 9th Dec
J&K
Priest-of [a temple-in Srinagar
beaten to death by a police man
in Srinagar.
30
31
1988, 17th May
Maharash
tra
Shiv Sena mob goes berserk,
riots in Aurangabad, following the
adjournment^ of a court hearing of
a petition challenging the election
of the mayor. 11 killed, 136
injured, 11 cases major arson,
over 600 arrested.
1988, 19th May
Maharash
tra
Communal j violence- in two
villages of, Marathwada district
following
the
incidents
in
Aurangabad; 8 killed, 11 injured,
6 houses and 13 muslim shops
burnt
1988, 20th May
Maharash
tra
Riots in Jalna in Marathwada
district after Shiv Sena try to hoist
it’s flag near the Jama Masjid. 2
killed, 45 injured.
1989, 13th Jan
J&K
Riots in Jammu city following
certain slogans raised by the
processionists on Guru Gobind
Singh’s birthday. 6 killed, over
100 injured]
1989,
March
22nd
Maharash
tra
Miscreants throw colour on the
mosque. Riots in Dhule-district. I
killed, 4 injured in police firing.
1989, 14th April-
UP
Riots between two communities in
Kalpi
during
a
religious
procession. I
1 killed in stabbing, 4 injured in
bomb explosion, 25 arrested.
1989, 16th April
UP
Bajrang dal ' activists try to insfal
idol of Hanuman in Jama masjid
in Mathura. Altercation wjth
Muslims assembled for evening
namaz. Arson and rioting in
Mathura. 6 njured. 34 shps, 11
houses looted
and burnt 4
I
mosques raided, copies of
koran burnt.
1989,10th May
1989, May
Rajasthan
Riots in Tonk following the murder
of a person by members of
another community. 24 injured in
police firing, 58 arrested, 7
shops damaged, 3 hutments
set on fire, 175 weapoqs
recovered.
Karnataka- 3 killed in- Kcllagal following
Communal riots. 8 injured, 70
arrested.
31
32
Bihar
1989, May
Over 40 killed,
shops gutter^.
» <*
1989, 3rd July
Maharash
tra
1989, 7th July
Ladakh
1989, 14tt July
Tamil
Nadu
UP
1989, August
1989,
August
Communal r ots in Hazaribagh
during Ram Navami festival.
12th
1989, 21st Sept
Bihar
Bihar
Bihar
muslim
Following a tandh called by the
Shiv Sena, BJP; RSS, 5000
strong procession in support of
the bandh was stoned while
passing through place of religious
worship. 4 killed in police firing.
Riots in Leh following a dispute
between the members of two
communities, [over 20 injured.
Riots in-Aruppukottai over fixing
of flag posts near Shiva temple by
a certain community. 11 injured
in police firing, 3 killed.
Riots in Meerut. 1 kiltecji
stabbing, 3 injured.
in
Communal Rots in Bhagalpur. 6
vehicles
burnt,
government
number of people injured.
Riots in Sasaram town . 5 killed,
16 injured.
1989, 21st Sept
31
|
Communal Violence in Palamau
district when group from one
community i damaged
burial
ground in village. 5 killed, 4
injured, 47 arrested.
1989, 14th sept
Rajasthan
1989, 28th Sept
UP
1989, 10th Oct
Gujarat
1989, 9th OCT
Karnataka
1989, 17th Oct
NorthCentral
India
Riots ir, Kota following religious
process on. 16 killed.
Communal riots in Badaun
following disturbances in a
procession in; support of official
upgradstion of Urdu language.
Violent mobi attack passenger
train. 23 killed, over 200 injured.
Riots in Vijaypur town following
disturbances : in
Religious
process on. 1 killed, 2 injured.
Riots in Hospet after mobs
belonging to- two communities
clashed
following
Dusshera
celebrations, ^ killed, 4 injured.
The Ayodhya dispute was the
cause of widespread Communal
violence; over north and central
Indian statqs following t^e
announcement of the dates of Lok
Sabha elections. Over 100 killed
32-
33
in the ripts.
1989, October
Maharash
tra
1989, 10th Oct
Rajasthan
o|d
Communal• Violence in
Nagpur over the issue of
of
loudspeaker near place
worship, vehicles set on fire.
Riots in- Jhalawar and- Bhilwara
district following unauthorised
re igiousj procession. 1 killed and
4 injured in police firing.
1989, 13th Oct
MP
1989, 15th Oct
Gujarat
Bomb thrown at' Id procession
near Dh.ar in Indore. 65 injured
Riots in Sidhpurtown following a
religious procession. 1 killed, 4
injured.
Gujarat
1989, 17th Oct
Riots irj Patan town, Mehsana
district after public meeting held
by BJP. 1 injured. 1 Dargah and
20 mus im shops set on fire.
Bihar
1989, 17th Oct
Curfew imposed inJharia town
alter Ram- Shila procession Was
disturbed. 1 killed in police
filing, 20 injured, about 100
arrested.
Bihar
1989, 24th Oct
The Rsjm Shila Puja procession
was given permission to pass thru
Muslim locality by the collector
despite the protests of the
residents. Provocative slogan
eering during the procession. Tv/o
bombs were thrown. Mob went
berserk and killing, looting and
arson took place. Rumours of
Hindu rpassacre spread in nearby
villages and engulfed them in
communal frenzy. 1026 killed
(676 muslims), 2000 arrested,
3932 shops burnt , 891 shops
looted
and
fired,
3000
powerlooms looted and burnt,
37 mosques; 7 madrasas, 8
tombs and 5 shia imam baras
were destroyed.
1989, 6ih Nov
Bihar
Riots jinSasaram district over
Ram shila Puja Procession. 10
killed,,'51 injured, 102 people
arrested, 2 shops set afire,
Bombs
and
explosives
1989, Nov-
•
UP
recovered.
The murder of Hindu Jagaran
Manch activist in Fatehpui town
I
33’
34
led to rio s. 1 killed, vehicle
destroyed^
1990, 3rd Oct
Rajasthan
Riots
in
Udaipur
over
disturbances in the Rarrr Jyoti
Pocession. 1 killed, 13 injured,
shops ransacked and burnt.
1990, 3rd oct
Karnataka
Riots in Chennapatna over
incident ofi eve teasing. 2 killed
in police firing, 30
property set ablaze.
1990, 3rd Oct
Karnataka
injured,
Riots in Kolar during Id after 1
student wps stabbed to death. 16
killed, 15 injured. Shops set
afire.
1990,
Maharash
tra
Riots in Bombay after miscreants
pelted stopes at the truckloads
people returning from Id - a- Milad
procession*. 1 killed, 24 injured,
stone
pelting
mosque. ;
1990,
Maharash
tra
1990, 6th Oct
Karnataka
1990, 30th Oct
Gujarat
1990, 30thOct
UP
at
Bandra
riots in Morba village of Raigarh
district after a group of people
pelted stones at the Ram yatra
procession. 1 killed, 13 injured.
Riots in Devangere when Re.m
jyoti processionists went berserk.
18 killed, j
“Rasta roko” agitation by VHP and
BJP to mark kar seva for the
construction of Ram temple in
Ayodhya. 12 killed, 7 injured.
“Kar Sevaks" put their flag on the
Babri Masjid and demolish it. A
victory rparch in- Bijnore by
several hundred people. Stones
were petted on the processionists.
Riot breaks out in Bijnore. Over
200 killed- Over 400 injured.
1990, 29thOct
Rajasthan
1990, 2nd April
Gujarat
1990, 3rd April
Punjab
1990, 4th April
Gujarat
Army was, called in all the major
towns following the demolition in
Ayodhya. Py Nov2nd violence toll
in the state had risen-to 52.
Riots in Ahmedabad, Baroda and
Palanpur. *53-killed.
Bomb exploded in Hindu religious
processiop in Batala. 35 killed.
Communal
Violence
in
Ahmedabad after a stabbing
incident. 60 killed and extensive
damage to property.
34
35
1990,18th April
UP
Communa Riots in Kanpur. 220
arrested.
1990,21st April
UP
Hindu Sammelan organised by
the VHP.'stones- thrown at a
religious I procession.Riots
in
Mathura. Shops burnt.
1990
Maharash
tra
Gujarat
Riots in Manori village over clash
between two groups. 60 killed.
Communaj riots in Baroda. 3
killed in police firing.1 injured in
1990,2nd May
1990,30th May
Maharash
tra
stabbing. Buses set on fire.
Communal riots in Amravati
district.1 killed.26 injured. Mob
set 10 huts on fire;
1990,21st July
Bihar
Alleged rape and murder of a girl.
Spraying of blood on schoolgirls.
Riots
in
Lohardagga.
45
arrested.6 shops set on fire, x
1990
Rajasthan
Police open fire on religious
procession in Banswara district. 1
killed. Many injured.
1990,
September
2nd
TamilNad
u
Beating of) drums and provocative
Vinayak
sloganeering
by
processionst near a mosque
times.
during
noon
prayer
Communal riots in Madras. 3
killed in ^the riots. 12 injured.
1990,
September
2nd
1990,
September
4tn
Gujarat
1990, September
Gujarat
4tn
Gujarat
1990,
September
Karnataka
Property vyorth lakhs destroyed.
Riots in ^amnagaram. Zkilled.
Petrol pumps,industrial sheds,
huts set on fire by miscreants.
An aftermjath of the Ram Janma
Bhumi, Babri Masjid issue, riots in
5 Gujarat; towns, during Ganesh
festival. 1 Skilled, 24 injured.
Huge Ganesh procession led by
the BJPi Health Minister of
Gujarat, shouted anti-muslim
slogans ^nd threw stones in
Muslim localities. Looting and
burning of every muslim shop in
the route of the procession. Riots
in Baroda. 8 killed. 24 injured.
The Jama Masjid was partially
damaged!
Riots in Anand following Ganesh
festival procession. 3 killed.
More than 12 injured.
1990,
September
-4tn - Gujarat
Riots
i following
Ganapati
procession in Surat. 1 killed.
'
35
*
36
TamilNad
u
. 1990,15’"
September
1990,30'"
September
UP
1990. October
Karnataka
Riots in U hampuram, Madurai
district ovei; rights to worship a
Peepultree. ^killed.
Riots in cplonelganj in Gonda
district following Durga immersion
piocession.
Riots in ,different parts of
Karnataka following rumours of
bombing of the BabriMasjid in
Ayodhya. 1 killed. 30 injured. 27
arrested.
Delhi
1990,
Communal Riots in Old Delhi
near Idgah- 5 killed. 25 injured.
237 arrested.
AP
1990,
Communal riots in Old city of
Hyderabad and' the adjoining
Ranga Reddy district.
107
killed. 300 injured. 413 arrested.
1990, Dec7
AP
1990, Dec
UP
Weaponsapd explosives seized.
CommunalRidts claimed 155
lives in Hyderabad. 58 mosques
demolished, 200 religious sites
destroyed; Properties worth 30
lakhs destroyed.
Riots in | Agra and Aligarh
following the Ayodhya incident.
OveiiOOkilled.
Gujarat
1990, •
1990, 8th Dec
UP
1990,December
UP
1990,
December
Gujarat
9,n
Riots
in ; Sabarkantha
district.
1 killed. 34 killed in Ahmedabad.
4 Passengers from Delhi bourjd
Gomti express.killed in riot torn
Aligarh town. 16 killed in thp
riots;. Violence spread to Meerut
and
'
Varanasi. | 6 districts in UP
affectetd. 125 killed.
Riots in’ Agra
incited
by
prerecorded provocative audio
messages boomed by car stereos
in the nigpt. 22 killed.
Cricket ball hit state reserve
police men. One of the boys
injured in the police firing.
Muslims (jailed for bandh.Tension
resulted in riots in Ahmedabad.
39killed. I
1991,8'" April
UP
Buffalo eptered cane field. Riots
in Mustafabad village,Varanasi. 3
killed,1 injured.
1991,11'" March
WB
Communal clash in Nadia district.
1
36
i
37
7 killed, 13 njured.
1991,24th march
Orissa
Riots in Bhadrak following Ram
Navami procession. 11 killed.
During the BJPsponsored bandh
on 28tn March, vehicles and
houses set on fire by the mob
1991, 27th March
UP ■
16 killed, 2injured.
Riots in Saharanpur following
RamNavamj
procession.
10
killed, 284 arrested.
1991, 19lh May
UP
1991,20th May
UP
Election procession conducted by
BJPstorm I troopers
through
muslim locality leasd to riots in
Kanpur. 9 killed.
Communalrjots in Sikandrabad,
Bulandshahar district following
poll clash petween twoopposing
parties. 12 killed, 49 shpps
burnt.
1991, 23rd April
Gujarat
1991,215! April
Gujarat
Communal
riots in
Baroda
following
aggressive
electioneering by BJP. 9 killed.
Many injured.
CommunalViolence in Surat. ?
killed.
1991,16h May
MP
Communal Riots in Gogaon, Mf*.
5 burnt al|ve. 20 injured. 115
shops,kiosks
and
houses
destroyed.
1991, 24th July
Gujarat
Large scale communalViolencp
following Moharram procession in
Broach, Jambusarand Baroda. 17
killed
1991, 17th April
WB
1991,20,n May
UP
Communal Riots following a
bomb explosion in a prayer
meeting in Calcutta. 25 injured.
Communal
riots
in
Meerut
following elections. Muslimsand
scheduled castes vote for Janata
dal and Hi ndus vote for BJP. 3
I
killed.
1991, 3rd July
Delhi
1991, 20th July
Karnataka
Riots in Delhi following an
an
altercation
between
a
and
autor.ckshaw driver
___
__
pushcart driver. 2 injured in
stabbing, policevehicle attacked
by ricters.
Communal riots following an
incident oof eve teasing apd
group clashes in Basava Kalyan.
I
37
38
3 killed and 10 injured in
policefiring. 3 huts set on fire.
1991,
November
8,n
UP
Communal Riots following the
Kali immersion procession. 17
killed.
1991,
January
1991,2""
February
26,n
1992,
february
12tn
UP
CommunalViolence in Ghaziapad.
10 killed. 254 arrested.
Karnataka
UP
1992, 24th June
UP
1992, 1st July
WB
1992, 2nd July
Gujarat
CommunalViolence in
Sulli^.
5injured. Large number of shops
and houses)gutted.
Riots in H^pur town following a
over
temple.
9
dispute
killed.Over 20 injured.
2 killed in Communal riots in
Bilaspur. 24 arrested. 1 injured.
CommunalRiots
in
1 killed.
Hoogly distpct.
Riots breakout on the eve of Rath
Yatra in ^hmedabad. Over 27
killed. Several hundred injured.
1992, 19th July
Kerala
1992, 19th July
Maharash
tra
Crores worth property damaged.
6 killed in
I CommunalRiots in
Thiruvananthapuram.
R.ots in M|alegaon following the
controversy.
3
Ayodhya
killed,116 njured. 101 arrested.
1992, September
Gujarat
1992
Guijarat
1992, 6th October
Bibar
1992,
October
Rajasthan
26tn
1992, December
Maharash
tra
Gujarat
Communal, riots in
following the Ganesh immersion
procession! 3 killed, 24 injured.
Riots in >f\nand over issue of
diversion of immersion route by
the police. |1 killed.16 injured.
48 killed in communal riots in
Sitarnarhi. Over 100 injured.
32 arrested in Communal riots
in Ajmer.! Shops and vehicle^
damaged by rioters.
Follcwing I the demolition of
BabriMasjip
in
ayodhya,widespread
communalriots in Bombay. Over
400 killed (137 in police firing)
1S92,December
Gujarat
Week long Communal Riots in
Surat
after
the
Ayodhya
demolition 300 killed. 30 women
raped.
20
industries
looted,burnt, 1000 houses and
shops burnt. 15 mosques and
two temples damaged.
38
39
1992, 5,h January
Maharash
tra
Communal Riots in Bombay and
215 killed ip
Ahmedabad.
Bombay. 1^00 arrested, 2000
preventive
placed
under
detention.
1993, 6Ih January
1993,
January
27tn
Ma ha rash
tra
Second Phase of Communal
Riots, triggered by 113 “Maha
Artis” attended by hundreds of
BJP and Shiv Sena men
accompanied by anti9-muslim
slogans, in Bombay following the
Ayodhya incident.
Over 557
killed. ( 133 in police firing, 259
in mob violence, 66 in arson).
Majority Muslims. Loss of
property worth Rs.4000 crores.
Delhi
Riots in Delhi following rumours
of desecration of religious place.
2 killed,6 injured,vehicles and
shops burnt
1993,
September
27th
MP
Ganesh
Riots
fqllowing
procession in Mandsaur. 58
arrested.
1993,
September
29tn
Gujarat
1993, 3fa May
Manipur
1994,
Goa
Riots in Surat during Ganesh
immersion ' procession.
4
killed,! injured.
98killed in Communal violence
in
Manipur.
93
of them
Muslims.
'
I
Riots in Mapusa after Police
prevented illegal Ganesh temple
construction. 22 arrested. A|i
BJP, Shiv sena workers.
1994,
February
10in
1994, July
UP
Gujarat
Hindu mobs attack muslim
residents in Kanpur in retaliation
of a Bomb explosion that killed
local BJP politician.
Communal violence in 4 villages
of Nadiad taluka on Muharram
day. 1 killed in policefiring.
Police lathicharge BJP supporters
wanting to Hoist national flag in
Idgah maidan. 6 killed in police
I
1994,15th August
Karnataka
firing. 34 injured.
arrested,
i
1994, 21st August
Karnataka
Over
30Q
Communal I violence following
disturbances'in a Id procession.
Anumber of weapons recovered
by the police. 2 killed. Over 200
39
40
vehicles burnt Over 50 shops
and hotels razed. 250 bicycles
burnt.
1994, 7th October
Karnataka
Communal Riots following an
anti-urdu telecast protest March in
Bangalore.
25
killed,
343
injured.
1994,
December
7'"
Gujarat
1994,
October
14m
Karnataka
Riots in Ahmedabad, provoked by
a groupwanting toperform Maha Arti on the second anniversary of
the demoloitio i of Babri Masjid in
Ayodhya.
Riots in
Qevangere during
Dusshera procession. 4ki!led,53
injured.
1995,
10‘"
February
1995, 10th March
UP
Communal riots in Moradabad. 4
killed.
UP
i
CommunalRiots
in
Skilled,
19
arrrested.
i
injured,
40
Aligarh.
308
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Everybody Loves A Good Drought
317
ROUGHT IS, beyond question, among the more serious
problems this country faces. Drought relief, almost equally
beyond question, is rural India’s biggest growth industry.
Often, there is little relation between the two. Relief can go to
regions that get lots of rainfall. Even where it goes to scarcity
areas, those most in need seldom benefit from it. The poor in
such regions understand this. That’s why some of them call
drought relief teesra fast (the third crop). Only, they are not the
ones who harvest it.
A great deal of drought ‘relief’ goes into contracts handed
over to private parties. These are to lay roads, dig wells, send
out water tankers, build bridges, repair tanks—the works. Think
that can’t total up to much? Think again. The money that goes
into this industry in a single year can make the withdrawals from
Bihar’s animal husbandry department look like so many minor
fiddles. And the Bihar scam lasted a decade and a half. The
charm of this scam is that it is largely ‘legal’. And it has soul. It’s
all in a good cause. The tragedy, of course, is that it rarely
addresses the real problems of drought and water scarcity.
In 1994-95 alone, the rich state of Maharashtra spent over
Rs.1,170 crores on emergency measures in combating drought
and on other water-related problems. This was more than the
combined profits the previous year of leading companies all
across the country in the organised sector of the tea and coffee,
cement and automobile industries. Their profits after tax came
to Rs.1,149 crores, according to . a report of the Centre for
Monitoring the Indian Economy.-(‘Corporate Finances: Industry
Aggregates’, CMIE, November 1994, Bombay.) <
In August 1995, Prime Minister Narasimha Rao inaugurated
an anti-drought project in Orissa. This one will involve spending
Rs.4,557 crores in six years (over Rs.750 crores a year) on just
a few districts including Kalahandi, Bolangir and Koraput. Every
paisa of that huge sum would be worth spending if it actually
fought scarcity and built better infrastructure. That, however, is
most unlikely. In part because the main causes of the problems
D
318
Everybody Loves a Good Drought
these areas face do not even begin to get addressed.
In theory, drought-prone blocks come under a central
scheme known as the Drought-Prone Areas Programme
(DPAP). But bringing blocks into the DPAP is now a purely
political decision. The central allocation for DPAP may be
nominal. But once a block is under DPAP, a phalanx of other
schemes follows bringing in huge sums of money. The same
blocks then get money coming in under the employment
assurance scheme (EAS), anti-desertification projects, drinking
water missions and a host of other schemes. Well, some people
do benefit.
In several states, official data on DPAP show us many
interesting things. In Maharashtra, the number of DPAP blocks
was around ninety six years ago. In 1996,147 blocks are under
the DPAP. In Madhya Pradesh in the same period, the number
of DPAP blocks more than doubled from roughly sixty to around
135. In Bihar, there were fifty-four DPAP blocks right through the
’80s. This became fifty-five when Rameshwar Thakur became a
union minister in the early ’90s. His home block in Bihar came
under the scheme. Today, there are 122 DPAP blocks in that
state.
?
All this has happened during a period where there have been
several successive good monsoons. There has been scarcity too
for some people. But that’s a different story.
Kalahandi’s major problem, as the reports in this section,
show, does not arise from poor rainfall. Water resources experts;
and administrators would largely agree that, barring problems of •
erratic timing and spread, most Indian districts could get by on
around 800 mm of rainfall annually. The lowest rainfall Kalahandi
has had in the past twenty years was 978 mm. That is way above
what some districts get in ‘normal’ years. Otherwise, Kalahandi’s
annual rainfall has been, on an average, 1,250 mm. That is pretty
decent. In 1990-91, the district had 2,247 mm of rainfall. Besides, .
Kalahandi produces more food per person than both Orissa and
India as a whole do. Nuapada, the worst part of old Kalahandi,
Everybody Loves A Good Drought
319
and now a separate district, got 2,366 mm of rainfall in 1994.
In Palamau, too, average rainfall is not bad. The district gets
1,200-1,230 mm otrain in a normal year. In its worst year in
recent history, it received 630 mm. Some districts in India get
less without experiencing the same damage. .
Surguja’s rainfall seldom falls below 1,200 mm. In some
years it gets 1,500-1,600 mm. That’s roughly four times what
California gets. And California grows grapes.:
£*
Yet, all these districts have problems relating to water that
are quite deadly. Very different ones from those the funds
address. Simply put, we have several districts in India that have
an abundance of rainfall—but where one section, the poor, can
suffer acute drought. That happens’when available water
resources are colonised by the powerful. Further, the poor are
never consulted or asked to < participate ?jn designing the
‘programmes’ the anti-drought funds bring. : •: -c S e.. •
~ hOnce it was clear that drought and DPAP were linked to fund
flows in a big way, it followed that everyone wanted their block
under the scheme. In many cases, the powerful are not only able
to bring their blocks under it, but appropriate any -benefits' that
follow.
r f ■
Take Maharashtra. Around 73 per cent of<sugar cane
produced in the state is grown in DPAP blocksl And sugar cane
is about the most water-intensive crop you can get. Secondly,
the area under irrigation in Maharashtra is pathetic/ dust inching
towards 15 per cent of crop land. But in the DPAP blocks, in one
estimate, it is 22 per cent-^-nearly 50 per cent higher than the
state average. Annual rainfall in Lonavla nearPune seldom falls
below 1,650 mm and can touch 2,000 mm. Lonavla is a DPAP
block.
• .
••
v- :
<
The many hundreds of crores spent in Maharashtra on relief
and on irrigation over the years have not led to any appreciable
rise in land under irrigation. In the DPAP blocks are small farmers
who really feel the pressure. The water is cornered by the rich
and the strong. Governments kid themselves that by throwing
320
Everybody Loves a Good Drought
money at such regions, the small fish, who have big votes, can
be pacified. In reality, the lion’s share of funds going there is again
appropriated by the powerful. And irrigation water? About two
per cent of farmers in the state use around 70 per cent of it.
Drought is a complex phenomenon. You can have an
agricultural drought, for instance, even when there is no
meteorological drought. That is, you can have adequate rainfall
and still have crop failure. Or you can have hydrological drought,
with marked depletion of rivers, streams, springs and fall in
groundwater levels. The reasons for these are well known but
seldom addressed. It is so much nicer to just put the whole thing
down to nature’s vagaries. It also works this way because so
many forces, at different levels, are either integrated, or get
co-opted, into the drought industry. The spiral from the drought
scam touches the global stage before returning.
Here’s how: Take any one district. Say Surguja (it could be
any other). The peasants face many water-related problems.
Block-level forces—contractors and politicians—take up ‘the
cause’. The complaint, typically, is: Our block got far less funds
than the others. The collector is ignoring us. That’s why its
happening.
Well, two things are happening, really. One, the peasants of
Surgujaface serious problems that are intensifying. Two, specific
forces are making a pitch at the.district headquarters for bringing
more funds to the block;
.
r.
•:• £ >
The local stringer of a newspaper (based in, say, Bilaspur),
takes up the theme: the collector is neglecting ‘our block’. Most
newspapers*pay their stringers a pittance. Some stringers get as
little as Rs.50 a month. So only those with other sources of funds
can work in this capacity. In many parts of these districts, you
will find that the stringer is often a small shopkeeper, a petty
businessman.
If contracts for various ‘public works’ come to the block or
district, the stringer might be among the beneficiaries. This is not
true of all, but does apply to quite a few stringers. I met many
Everybody Loves A Good Drought
321
intelligent, resourceful people among, them. They are bright,
have an ear to the ground, react quickly to situations. Quite a few
of them are also small contractors. So are many block-level
politicians. (So are many national politicians and newspaper
owners, but that’s another story.)
<•’
• -:
Reports of raging drought put pressure • on a district
administration strapped for resources. (Some of the stories have
strong elements of truth, though death counts are. often
exaggerated.) The collector calls his friends: the district level
correspondents. He explains that his district gets far less from
the state capital than other; neighbouring ones. This could well
be true. The collector is also pitching at the state capital for a
better share of the resource cake. Reports of ‘stepmotherly
treatment’ of Surguja, or whichever district it is, start appearing
in newspapers in the state capital.
• ' •• n i
i ;•
That embarrasses- the state government.tHow does it
respond? While doing what it can locallyalso, pitches at the
Centre for more: funds ? to deal with rthe drought?: State
governments often bring down correspondents from mainline
journals to the state capital. These reporters then set off on a
guided tour of the ‘affected areas’. Governments often have
- vehicles reserved for the purpose of press tours. And often, a
senior official goes with the journalists to the trouble spots. .
The sophisticated writers of the urban press are superior to
the local press when it comes to the heart-rending stuff.fThe
drought becomes a ^national issue. Copy full of ■ phrases like
‘endless '■ stretches ?of ^parched larid’^.accompanied by
photographs, reaches urban audiences: (Now parched:land is
not necessarily a symbol of drought. You can have it in very wet
places if you drain a pond^And you can have an acute water
shortage in seemingly green areas. But parched land makes
better copy and pictures.) This is more true of the English press.
The1 language press has serious problems,‘but is closer to the
ground.
’
*. • « ? •If it is, say, mid-May when reporters reach the affected
322
Everybody Loves a Good Drought
region, the searing heat will impress some. With your skin and
hair on fire, it is easy to believe there has been drought in the
area since the dawn of time. There could be flooding here two
months hence, but that*-doesn’t matter now. Unlike the
quick-on-the-uptake local stringers, the national press is seldom
clued in on ground reality. There are, of course, many reporters
who could handle the real stories of the place. They don’t often
get sent on such trips. Those are not the kind of stories their
publications are looking for. Every editor knows that drought
means parched land and, hopefully, pictures of emaciated
people. That’s what ‘human interest’ is about, isn’t it?
The state has made its pitch at the Centre. The Centre is
unfazed. It uses what it considers examples of responsible
reporting (that is, reports that do not vilify the Centre) to
advantage. It makes its own pitch for resources. International
funding agencies, foreign donors, get into the act. UNDP,'UNICEF, anyone who can throw a little money about. The global
aid community is mobilised into fighting drought in a district that
gets 1,500 mm of rainfall annually.
•
The reverse spiral begins.
- •.
,
Donor governments love emergency relief. It forms a
negligible part of their spending, but makes for great advertising.
(Emergencies of many sorts do this, not just drought. You can
run television footage of the Marines kissing babies in Somalia.)
There are more - serious issues between rich and poor
nations—like unequal trade.. Settling those would be of greater
help to the latter. But for that, the ‘donors’ would have to part with
something for real. No. They prefer emergency relief.
So money comes into Delhi from several sources. The next
step in the downward spiral is for central departments to fight
over it. Nothing awakens the conscience like a lot of money. One
department or ministry remembers it has a mission to save the
forests of the suffering district. Another recalls a commitment to
manage its water resources.
Then there are all the hungry, Rs.30,000-a-month
Everybody Loves A Good Drought
323
consultants to be clothed and fed. Projects are drawn up with
their assistance for fighting drought in the district. Or for water
resource management. Or for anything at all. Studies of water
problems are vital. But some of these are thought up simply
because there are funds now. (The collector and a lot of peasants
in the district could probably tell you a great deal about the real
water problems. But they’re not ‘experts’.)
The money goes to the state capital where the struggle over
sharing it continues. At the district level, the blocks pitch for their
share. Contracts go out for various emergency works. A little
money might even get spent on those affected by the water
shortage. But it cannot solve their problems.
The next year the same problems will crop up all over again
because the real issues were never touched.
At the end of it, mahy forces including well-meaning sections
of the press have been co-opted into presenting a picture of
natural calamity. Too often, into dramatising an event without
looking at the processes behind it. The spiral works in different
ways in different states. But it works.
And yet, so many people do suffer from water-related
problems. Several of India’s more troublesome conflicts are
linked to water. It may have taken a back seat, but the sharing
of river waters was a major part of the Punjab problem. The
ongoing quarrel between Tamil Nadu and Karnataka is over
Cauvery waters. (Some of India’s tensions with Bangladesh have
their basis in water sharing disputes.) The struggle over water
resources operates at the micro, village level, too, in many ways.
Between villages, between hamlets within a village, between
castes and classes. (For more on drought-related issues, also
see the sections on displacement, survival, usury and fightback.)
Conflicts arising from man-made drought are on the rise.
Deforestation does enormous damage. Villagers are
increasingly losing control over common water resources. The
destruction of traditional irrigation systems is gaining speed. A
process of privatisation of water resources is apparent in most
324
Everybody Loves a Good Drought
of the real drought areas (take the water lords of Ramnad, for
instance). There are now two kinds of drought: the real and the
rigged. Both can be underway at the same time, in the same
place. As the reports that follow seek to show, they often are.
Open acccsf, froaly avalldblo onlltlt
Should Health Professionals Allow Reporters
Inside Hospitals and Clinics at Times
of Natural Disasters?
Health professionals must protect their patients' dignity and privacy
Anant Bhan
This is one of seven
articles In the June
2005 issue that
revisit the tsunami
six months on.
he tsunami that marked a
solemn end to 2004 left behind
unprecedented devastation. The
world was shocked al the increasing
casualty figures and the real-time
images of the disaster brought by the
news media. These included dips and
photographs of dead bodies, grieving
relatives, and suffering patients admitted
to makeshift emergency wards.
The photographs did help in
organizing a quick response from the
rest of the world, as societal pressure
led governments and relief agencies
to respond with comprehensive
relief measures. Graphic foolage and
newspaper headlines continue to dwell
on this human tragedy. However, both
health-care workers and journalists
need to carefully consider whether it
is ethical to show images of patients
in obvious distress and undergoing
medical attention in emergency camps,
or of dead bodies in hospital morgues.
T
Ethical Guidelines
There are many published guidelines
that journalists can tum to for guidance
on the ethics of reporting. For example,
the UNESCO International Principle's <>i
Professional Ethics in Journalism details
the principle of respect for privacy and
human dignity as an integral part of the
professional standards of a journalist
[1]. The Australian Journalists Code of
Ethics calls upon journalists to respect
The Essay section contains opinion pieces on topics
of broad interest to a general medical audience.
PLoS Medicine | www.plosniedlcine.org
DOI. I(l. 1371/join nal piiic(l.0<l20l 77 gUOl
During disasters, journalists and health professionals must respect patients' privacy
(lllustrat|on;Giovanni Maki)
private grief and personal privacy, and
reinforces the right of joinnalisis to
resist their compulsion to intrude [2].
The Code of Ethics and Professional
Conduct ol the Radio-Television News
Directors .Association, the world’s largest
professional organization devoted
exclusive!) to electronic journalism,
expects professional electronic
journalists to treat all subjects of news
coverage with respect and dignity,
showing particular compassion to
victims of crime and tragedy [3J.
However, there has been little
consideration to dale of the ethics
ol heallhaarc stall allowing access to
media inside medical institutions al
limes ol ii.iim.il disasters In a 2003
editorial in the BMJ, which discussed
“man-made” disasters such as war,
Singh and DePellegrin questioned the
use of footage of casualties from the
Iraq war without the patients’ consent
[4]. An extensive debate followed
publication ol the commentary (see
hl t p://bmj. bin jjotirnals.com/cgi/
04/1
elelleis/326/7393/774); one oflhe
views expressed was the need to show
the world the extent of killing and
maiming in the war (hitp://bmj.
bmjjournals.c'om/c gi/elettcr.s/326/
7393/774//31147),
Citation: Bhan A (2005) Should health professionals
allow reporters Inside hospitals and clinics at times of
natural disasters? PLoS Med 2(6):el77.
Copyright: © 2005 Anant Bhan.Thls Is an open
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly
cited.
Anant Bhan is at the Centre for Studies In Ethics
and Rights (CSER), Mumbai, India, and is currently
a Fogarty International Fellow at the University of
Toronto Joint Centre for Bioethics (JCB), Canada. Emall:anant.bhan@utoronto.ca
Competing Interests: AB Is a bioethics fellow
studying in Canada and a public health physician
from India, one of the countries most heavily affected
by the tsunami. He is presently the recipient of a
Fogarty International Fellowship.
DOI: 10.1371/journal.pmed.0020177
June 2005 | Volume 2 | Issued | el 77
M*HIr ( MVMNUI*
till* I'llIIAHlIl
Benefits and Harms
In the post-tsunami scenario, the
usefulness of (he Internet and media
was apparent. For example, a young
Swedish child separated from his family
was identified by his uncle on a hospital
Web site and later reunited in an
emotional moment with his laihci, who
had been admitted to anolhci hospital.
The publication on government and
hospital Web sites of the names of
those admitted to hospitals, together
with news releases, helped many
identify their friends and relatives.
Furthermore, the aid response has
been the hugest of any disasiei in
history, which may have been due to
the unprecedented media coverage.
There has also been the advent of
“disaster tourism"—the massive
inflow of well-meaning, but often illorganized, charitable organizations and
aid volunteers to the tsunami-hit areas
[5].
At the same time, the media
coverage of wailing relatives and
dead bodies lying in hospital
morgues is deeply disturbing. The
death of a loved one is a lime for
privacy and respect for the dead. As
a South Asian, I am aware that in
many communities the dead body is
covered with a shroud that denotes
purity. It is rare to photograph or film
funerals. To infringe on the privacy
of families when they are emotionally
shattered is disrespectful to the
living. Photographing and filming the
deceased in various stages of undress
and decomposition violates the dead
and their dignitary rights, according
to most cultures. In addition, the
hordes of news media that descend on
a hospital can hamper the efficiency of
the medical staff providing emergency
care, where even seconds arc i rucial.
The Role of Health Professionals
In Protecting Privacy
Health professionals and administrators
can and should control media access to
hospitals and clinics. The public’s right
to information should not outweigh
the right of victims of natural disasters
to privacy, confidentiality, and dignity.
Health professionals should be aware
that the filming of patients under
their care may be used not only for
highlighting the extent of a disaster’s
human toll, but also for commercial
purposes, such as selling programs and
PLoS Medicine | www.plosmedicine.org
m-w^pup'm,
fin i.ihing liimh I'm
thcac: ic.i.niib, exn cine caution .should
be used in giving permission to use
images horn inside hospitals in disasteraffected areas. Ideallv.
• the consent
ol the patients or surrogate decision
makers should be sought In
It is now the ethical noim
> ek
consent ol patients when photographs
ol them (or even ol theii bod) pails)
aie used in medical conferences
01 public ations (see the guidelines
on consent horn the Intel national
Committee of Medical Journal Editors,
at http://www.icn1jc.0rg///privac7).
A similar appioach should be taken
in the event ol natural 01 man-made
disasters. If photographs of the dead or
those admitted to hospitals have to be
publicized for identification purposes,
this should be done keeping local
sensibilities in mind.
It is difficult for health-care
professionals to shoulder this social
responsibility during a crisis when
lilcsaving im asmes < omc lust.
To infringe on the
privacy of families
when they are
emotionally shattered
is disrespectful to the
living.
Community consent and monitoring
through community leaders, tribal
elders, or local authorities might be an
option. Such community involvement
would result in media coverage that
would be socially and culturally
acceptable. While the usefulness of
documenting and transmitting such
geographically and experientially
diverse experiences around the world
is undeniable, the terms of access for
media have to be negotiated keeping
the notion of consent central.
With the increasing focus in
medicine and bioethics on individual
rights, the right to privacy is pivotal.
Doctors and other health professionals
have a duty ol care to their patients,
which includes protecting their
dignity and privacy. Ethical obligations
of health professionals to monitor
recording of images in health
institutions need to be higher (han
those of society in other venues, such as
the street or the beach.
0472
Ii may hr valuable' Im incdkal
piolcssionals to have a specific code,
pri haps wi itten by disaster-relief
oiganizations (such as the Red Cross)
together with the World Medical
Association, that outlines how to deal
with the media in disaster sellings.
Arguably, the universal obligation
of health-care pioicssionals and
administialois to lespccl the privacy
and confidentiality of their patients
should suffice, but given the nature of
realities on the giound in disasters and
emergencies, a specific code would be
useful.
Responsible Journalism
Responsible journalism in health-care
settings al limes of disaster, facilitated
by guidelines that specifically address
the ethical reporting of disasters and
(hat are applicable universally across
the woiId, will also help prevent
exploitation of victims of a calamity.
Such guidelines could be developed by
a joint body c ompi ised of intei national
medical humanitarian agencies such
as the Red Cross and Medecinssans
Frontieres (MSF), multinational
agencies such as the United Nations,
media representatives, and media
watchdogs.
The guidelines need to be acceptable
to the global media community and
also need to he made binding. For
example, sanctions could be imposed
upon journalists (or their parent
organizations) who ignore them, or
perhaps only those journalists who have
been accredited in “ethical reporting
of disasters” should be given access to
disaster sites.
The guidelines could also usefully
be published together with a code for
health professionals. An example of
joint guidelines on ethical reporting on
health issues for the media and health
care professionals are those adopted
in Washington State (hltp://www.
wsma.org/news/guide.hlml). These
guidelines were jointly approved
and prepared by media, publishers,
broadcasters, and hospital and medical
associations, and they could serve as a
template lor international guidelines
on disaster reporting.
Conclusion
In disasters, the affected are often left
with almost nothing and with negligible
negotiating power. They might be
left with only their pride and dignity,
June 2005 | Volume 2 | Issue6 | el77
and they must not be tubbed of that.
Patients or afTec led families might
not be in a condition to respond to
encroachment on their rights. While
health professionals want to facilitate
recognition of their unidentified
patients and also facilitate more aid
to affected areas, they also have an
enhanced responsibility to protect
their patients’ dignity and rights. We
should not need to be voyeurs into the
grief of vulnerable victims to launch an
effective and humane response to any
disasict. ■
2.
Acknowledgments
AB would like to thank colleagues and
fac ulty at ('SER and ]('B and the peer
reviewer lot helpful comtnents on this essay.
References
I. UNESCO International Principles of
Professional Echics in Journalism issued by the
Fourth Ccunuliative Meeting of Intel national
and Regional Oiganizations of Journalists in
Paris (20 Nov 1983) Available: http://www.
3.
I.
5.
journalism islam.de/konfcrcnzrn/t odcs.html.
Accessed 10 April 2005.
Media, Entertainment and Arts Alliance:
Australian Journalists Association, Code of
Ethics. Available: http://www.nt.gov.au/pfcs/
■ncdia/aboutus/ethics. Accessed 15 April 2005.
Code of Fthics and Professional ( undue! o! the
Radio Television News Dircctuis Association.
Available: hftp://www.nnda.oig/cthlcs/roe.
shtnil A< < cssrd 15 April 2tK)5
Singh J \. Drl’rllrgiin 11. (2003) linages ol wai
and medical ethics. BMJ 326: 774-775.
IANS (2005 Jan 7) Tsunami spawns
dlsiiMri unit Ism. Times of India. Available:
http://timrsolindia.lndlaiimes.com/
articleshow/983383.cms. Accessed lOJan 2005.
\xanart/c/ep
o
PLoS Medicine publishes articles that
represent significant advances In health
research—an experimental result, a
discovery, a clinical trial, or an analysis
that could lead to a change in thinking.
You can submit your paper online at
plosmedicme.org.
PLoS Medicine | www.plosmediclne.org
0473
June 2005 | Volume 2 | Issue 6 | el77
N tS S A R A H M A D
p M - 7- .
Death under snow
Avalanches kill several hundred people and cause heavy loss of property as Kashmir experiences its
worst snowfall in recent years.
SHUJAAT BUKHARI
in Waltengu Naar
OR many years, summer was harsh
in Kashmir with long dry spells that
affected agriculture. The reason for this
was the poor snowfall in winter. Even
Chila-e-Kilan, the harshest period of
Kashmir’s winter, which runs from mid
December to end January, did not see
much snow. The story was the same this
season too.
However, the second part of winter
beginning February, known as Chila-eKhored, turned out to be devastating.
The unprecedented snowfall, which
lashed the whole of Kashmir Valley and
parts of Jammu, took a heavy' toll of life
and property. As many as 300 people
F
FRONTLINE, MARCH 25. 2005
were killed and many are still reported
missing. Thousands of houses were de
stroyed. The damage to agriculture, par
ticularly
horticulture,
has
been
enormous.
The impact of the snowfall was first
felt on February 7, when the 300-kilometre-long Srinagar-Jammu national
highway got blocked and 17 soldiers of
the Indo-Tibetan Border Police (ITBP)
were swept away in the avalanches. Sri
nagar was buried under heavy snow,
which threw life our of gear. There was
no water or power supply. With the
shops remaining closed for three days,
(Top) Residents of Waltengu Naar in
South Kashmir carrying a body
recovered from the snow.
the demand for essential commodities
went up.
The State government, which was
caught unawares, is facing severe crit
icism for its inability to manage the crisis
caused by what is christened “snow-tsu
nami” by the regional press. “We were
not prepared for this havoc,” admitted
Taj Mohiuddin, Minister for Consumer
Affairs and Public Distribution.
While the plight of those living in
urban Kashmir got good media coverage,
south Kashmir had no such privilege
though a whole area was flattened by
avalanches. In Waltengu Naar, a cluster
of tiny hamlets in the Himalayan ranges
in south Kashmir, nearly 200 people
were buried alive in their hutments.
According to villagers here, mostly
43
N lS S A R A H M A D
A damaged house at Waltengu Naar.
(Right) Survivors at the relief camp
in Yar Khushipora.
herdsmen, the heavy snowfall started on
February 16. By the night of February
19, it had assumed dangerous propor
tions. As the avalanches started hitting
the mud hutments, some 100 residents
managed to get out of the snow chat was
10 to 16 feet high, the highest recorded
in recent years. They started trekking the
snowy slopes down towards Qazigund.
Ar the same time, a group of villagers
from the low-lying areas decided to walk
up to the inaccessible hamlets. The two
groups met halfway, and that was how
the news spread. According to Army
sources, a villager walked for 20 hours to
inform the nearest post of 49 Rashtriya
Rifles; the police acknowledged that they
were informed about the marooned vil
lage by the Army. “But the police were
the first to reach there,” said Nazir Ah
mad, an Assistant Sub-Inspector posted
at Qazigund.
However, on February 23, when
Frontline visited the village, residents
were waging a battle against the snow
with the help of spades and shovels, with
the 50-odd police and Army personnel
44
Bodies of those killed by avalanches at Waltengu.
present rendering not much help. Now
the area is thronged by many govern
ment agencies and non-governmental
organisations (NGOs) seeking co pro
vide relief and rehabilitation.
XCEPT graves, nothing is visible
now in Waltengu. “1 lost ten of my
family members as a giant wall of snow
slammed into our village,” says Abdul
Gani. a labourer. The dead include his
two sons, six-year-old Altai and 18month-old Aslam.
Master Bashir Ahmad, another resi
dent, lost 22 of his relatives to the ava
lanche. His two sons were rescued bur
onlv ro die in hospital for want of med
E
icines. His wife Hajra was rescued alive
from under the snow after three days bv
the villagers.
There is hardly a resident in Wal
tengu who has not lost a relative. “The
avalanches crushed everything. It killed
people and animals, and destroyed
trees,” said Muhammad Shafi, who was
attending to one ol his injured relatives
at the Qazigund hospital. He lost five
Relatives including his two-vear-old son,
but was caring for four others who survived.
Many children who have lost their
parents retuse to go back to their villages.
Mam- of them have nobodv to look after
them. Ar a m.'Ae-shift camp in Yar lx.hu•
•
J
* U W i H V H V S S IN
Vehicles stranded on the Srinagar-Jammu National Highway on February 22.
shipora, 6 km away from Wakengu, Ad
ditional Director-General of Police
(Armed) Kuldhip Khuda picked up three
such children for adoption. Many
NGOs are coming forward to help rhe
destitute children. The dozens of chil
dren at the camp still play in the snow,
but at night many of them wake up see
ing nightmares.
After the initial rescue operation, the
State may face another challenge - from
epidemics. Dr. Muzaffar Ahmed, Direc
tor, State Health Services, said that rhe
authorities were equipped to meet any
such eventuality.
Even as snow swept the whole valley,
the Army faced no losses. But all the
other forces - rhe police, the Border Se
curity Force (BSF), the Central Reserve
Police Force (CRPF) and the 1TBP had to pay a price. If the ITBP lost 17
men on Jawa rar Tunnel, the BSF lost
nearly a dozen men in the border district
of Kupwara.
The Army encountered unpreceden
ted weather conditions along rhe 750km-long Line of Control (LoC). Chief of
Staff of the Srinagar-based 15 Corps,
Major-General Raj Mehta, said that such
a situation had come about after 43
46
years. “There are places in the [western]
Uri sector where the accumulated snow
fall level is touching 70 feet. In Gulmarg
sub-sector where our troops are operat
ing, the snowfall level is 66 feet,” Gen.
Mehta said.
OR once, Kashmir became the desti
nation of top dignitaries for reasons
other than militancy. From Prime Min
ister Manmohan Singh to Congress pres
ident Sonia Gandhi, almost all those
who matter in New Delhi had made it to
Wakengu and other places to visit the
suffering. But leaders of the main Oppo
sition at the Centre, the Bharatiya Janata
Party, were missing.
The first to reach Srinagar was Sonia
Gandhi, along with Defence Minister
Pranab Mukherjee. She asked the gov
ernments in New Delhi and Srinagar to
speed up the relief work. The PrimeMinister, who too made an aerial survey
of the affected areas, announced that
Rs.l lakh each would be paid from the
National Relief Fund to rhe kin of the
deceased.
Union Home Secretary Dhirendra
Singh announced that a National Disas
ter Response Force will soon come up to
F
fight such tragedies. He said that eight
battalions from the BSF, the CRPF and
the ITBP would be specially trained for
the purpose. “One such battalion will be
shortly moved to Jammu and Kashmir to
be parr of the ongoing rescue oper
ations," he said.
Chief Minister Mufti Mohammed
Sayeed said the survivors in avalancheprone regions would be moved to safer
areas. “I assure them that the government will spare no effort to provide relief
to them and ensure adequate rehabilita
tion of the survivors - psychologically.
financially and logistically', he told
Frontline. The State government has an
nounced Rs. 1 lakh each as ex gratia pay
ment for the kin of the deceased.
The government sought Rs. 1,500
crores for relief and rehabilitation Rs.500 crores for immediate relief and
the remaining’for long-term rehabilitanon work - from the Centre.
1 he separatists too chipped in to
help the victims. Jammu and Kashmir
Liberation Front chairman Yasin Malik
was in the forefront of those walking the
long distance to the affected areas to pro
vide the survivors clothes, rood, med
icine and boots.
25, 2005
PREPAREDNESS
AND
MITIGATION
IN THE AMERICAS
9
I
News and Information for the International Disaster Community
Issue No. 80
April 2000
Identifying Cadavers Following Disasters:
Why?
ne of the most common myths associated
with natural disasters is the myth that
cadavers are responsible for epidemics.
In many cases, the management of cadavers is
governed by the false belief that bodies represent
a serious threat of epidemics if they are not imme
diately buried or burned. This threat is used as a
justification for widespread public health malprac
tice that gives top priority to mass burial or cre
mation of victims. More than simply being scien
tifically unfounded, this practice leads to serious
breaches in the principle of human dignity by
depriving victims of an appropriate identification
and disposal of their body.
The debate about the issue of mass disposal of
bodies of victims who have died from trauma due
to a disaster cannot be solely confined to the pub
lic health arena. In fact, in this case, public health
is a non-argument. This remains a problem despite
the fact that in most countries, domestic laws pro
vide a series of requirements for the proper dis
posal of bodies.
The real challenging argument for the appropri
ate management of dead bodies is the recognition
O
News from
PAHO/WHO
2
Other
Organizations
3
that identification and proper disposal of a dead
body—if not clearly and unambiguously in legal
terms a basic human right—is at least a basic
human need.
When someone dies, there is not only a legal,
societal need to identify the person, but also the
human need for the moral comfort of his/her rela
tives. Following the July 1995 massacre in
Srebrenica, Bosnia, for more than a year the
women of Srebrenica demonstrated in the streets
of Tuzla, demanding to know from humanitarian
agencies, the United Nations and the Red Cross, if
their husbands were still alive and being kept pris
oner or had been massacred. The mental anguish
of survivors is no less following natural disasters
and yet in many instances we have witnessed
unnecessary precipitous mass burials. Contrast
that to the seemingly endless efforts by the U.S.
Government, even 25 years after the end of the
Vietnam War, to obtain some means of identifica
tion of still unaccounted for MIA/POWs. Are the
needs of the relatives of hurricane or earthquake
victims less important?
(cont. on page 7)
Member
Countries
A Course For Managers m Health,
Disasters and Development
4
Review of
Publications
6
Selected
Bibliography
8
Supplement on
Mitigation
S1
ISSN 1564-0701
o longer is it enough to have an excellent
technical grasp of the epidemiological
consequences of disasters or the structural
vulnerability of hospitals. Today, the decentraliza
tion and reform processes that are underway in the
countries of the Region have significantly
changed the tasks of the national disaster program
N
coordinators. At the same time, the globalization
of humanitarian assistance has stimulated the
interest of a greater number of new actors with
whom the national authorities must interact.
Among them arc financial organizations, NGOs
and foreign militaries.
(cont. on page 2)
ew§ from FAHO/WHO
u
A Snapshot of Donations to
Venezuela
SUMA, the Humanitarian Supply
Management Sys
tem, was in place in
Venezuela immedi
ately following the
December 1999 floods.
The system captured
very detailed infor
mation on incoming
humanitarian relief
that poured into the
country, making it possible to confirm several
longstanding observations:
• Local communities are the first to help. The ini
tial response was from the country itself.
SUMA began registering incoming donations
from other parts of Venezuela on December 17,
the day after the rains ceased. Nine days later,
SUMA began registering the first foreign aid
donations.
• International assistance arrives later, but in
abundance. Foreign donations registered by
SUMA outnumbered local ones. Two-thirds of
all in-kind donations came from the internation
al community.
• The system can become clogged with non-priority items. More than half of medicines received
were not urgently needed.
Snapshots such as these confirm the need for a
In order to tackle this increasingly complex situ
ation, PAHO/WFIO is organizing LIDERES, a
course to respond to the demands of institutions
that can no longer rely solely on professionals
knowledgeable about disasters, but rather, urgent
ly require managers.
This international course will focus on the man
agerial aspects of disaster reduction programs,
from prevention to response to risk management,
covering topics such as the globalization of relief,
decentralization, information management for
decision-making, project preparation, negotiation,
mobilization of funds, the organization of work in
2
global education campaign on in-kind donations, a
step called for in the last issue of this newsletter.
For more information on the flow of donations
to Venezuela, compiled by SUMA, please visit
www.disaster.info.desastres.net/SUMA/.
WHO Guidelines for Vegetation
Fire Events Available Online
The WH0-UNEP-WM0 Guidelines for
Vegetation Fire Events (see issue 77 of this
newsletter)
is available online
a(
www.who.int/peh/ (click on "Air" and then on
"Vegetation Fires"). Background papers and the
teacher’s guide are also available at the same
address.
Radiation: Before, During and
After Radiological Emergencies
PAHO has just translated this technical refer
ence document and adapted it for Latin America
and the Caribbean. This Spanish-language adapta
tion (it was originally published by WHO in
English) is designed to improve the response to
this type of accident in the Americas and is espe
cially directed to local authorities. It is a useful
reference volume for developing educational
plans, preparedness measures, response plans, and
mitigation programs for nuclear or radiological
accidents. A limited number of copies is available’
in Spanish from the CRID (see page 8).
unsafe areas, and transparency in relief manage
ment.
This first course will be conducted in Spanish
and held in Quito, Ecuador from 28 August to 15
September and will be limited to 24 participants.
Following the model of other international
courses, a registration fee of US$1,500 will ensure
sustainability of this event. An additional
US$1,300 will be charged for lodging, food and
local transportation. The deadline to register is 15
July. For more information contact: cursolideres@paho.org.
Disasters: Preparedness and Mitigation in the Americas • April 2000
^Jther
rgamzatooDis
HELP 2000: Health Emergencies
in Large Populations
This three-week course is designed to develop
or improve the skills of persons and organizations
providing emergency health services in humani
tarian emergencies. In 2000 it will be held from
July 10-28 at the Johns Hopkins School of Public
Health. Baltimore and from 17 July-4 August in
Honolulu at the University of Hawaii.
Topics covered in the course include planning,
food and nutrition, environmental health, commu^licable diseases, health services, epidemiology,
humanitarian ethics and international humanitari
an law. The courses are co-sponsored by the
International Committee of the Red Cross
(Geneva), the American Red Cross and PAHO.
Contact Dr. Gilbert Burnham, fax: (410) 6141419; e-mai 1: helpcour@jhsph.edu.
Disaster Management Certificate
Offered
The Center of Excellence in Disaster
Management and Humanitarian Assistance
(CEDMHA) and the University of Hawaii-Manoa
introduced a new multidisciplinary training and
research program leading to a Certificate in
Disaster Management and Humanitarian
Assistance. The new program will draw on the
Asia-Pacific expertise of the university faculty
4^and the extensive field experience of CEDMHA
staff. Participants will include both civilian and
military students.
For additional information contact CEDMHA
fax: (808) 433-1757; http://coe.tamc.amedd.
army.mil or e-mail: jwhite@havvaii.edu.
Saving Older People's Lives in
Emergencies
Older people, especially older women, are a sig
nificantly vulnerable group in disaster situations.
HelpAge International’s new guidelines for best
practices in humanitarian crises and disasters,
Older People in Disasters and Humanitarian
Crises, show how aid agencies can meet older
people’s needs and recognize their potential in
emergencies. Simple changes in practices and atti
tudes can often make the difference between death
and survival.
These guidelines are available in English,
French, Portuguese and Spanish. The full docu
ment is posted in English at www.helpage.org.
For further information contact HelpAge
International, fax: (44-020) 7404-7203; e-mail:
press@helpage.org.
World Disasters Report 2000
The International Federation of Red Cross and
Red Crescent Societies (IFRC) will publish the
World Disasters Report 2000 on 29 June 2000.
The focus this year is on public health in disasters,
and covers assessing and targeting public health
priorities, AIDS in Africa, the Kosovo crisis, the
need for legislation in disaster response, the quan
tity of aid, plus a "disasters" database with statis
tics on disasters and epidemics (supplied by the
Center for Research on the Epidemiology of
Disasters in Belgium) and refugees (from the U.S.
Committee for Refugees). The publication will be
available online at www.ifrc.org/pubs/wdr/. For
more information please contact: Isabelle
Grondahl, e-mail: tempcom2@ifrc.org.
Volcanologists Chat Online
A new tool for direct online discussion has been
introduced by the University of Rome’s Physics
Department. This tool may be accessed free of
charge at: http://vulcan.fis.uniroma3.it/message/
v-board/start.html.
ADPC Course Focuses on
Community-Based Management
The Asian Disaster Preparedness Center will
host the Fourth International Course on
Community-Based Approaches to Disaster
Management from 3-14 July 2000 in Bangkok,
Thailand.
The course will provide enhanced understand
ing of community-based approaches to disaster
risk management through strengthening of local
capacities. It will highlight the importance of col
laborative working and development of strategies
for local level partnerships between government,
local officials and communities to achieve more
advanced preparedness.
Nominations are invited. To obtain applications
and more information, please contact ADPC at email: tedadpc@,ait.ac.th; fax: (662) 524-5360, or
visit their website at: www.adpc.ait.ac.th.
Disasters: Preparedness and Mitigation in the Americas • April 2000
3
ouontries
Seminar on Environments! and
Technological Emergencies
www.geologia.ufpr.br/ochaundac or by email:
monteirojiereira@un.org.
OCHA and the Federal University of Parana,
Brazil are organizing a seminar on 5-9 June, 2000
for disaster professionals to strengthen regional
capacity in responding to disasters and to promote
the response system used by the UN as well as
several tools used in evaluation and coordination,
including the response to environmental emergen
cies. More information may be found at:
Caribbean Discusses
Environmental Management
Follow Up on Volcanic Emergency in Ecuador
ollowing is an update on health sector
response to the continued volcanic activ
ity in Ecuador.
F
Epidemiological surveillance
The Ministry of Public Health is publishing
the newsletter Volcanes, to provide informa
tion on the effects of volcanic eruptions on the
health of Andean populations; specifically, the
correlation between volcanic ash fall and respi
ratory problems, conjunctivitis, tuberculosis
and asthma. The Newsletter is available at
www.disaster.info.desastres.net/PED-Ecuador/
desastre/boletin volcanes.htm.
Safe drinking water is always one
of the most critical needs.
Photo: PAHO/WHO
Mental health
Monitoring of the health situation has detected some cases of post-trau
matic stress disorder in the affected population. Psychologists from the
Ecuadorian Red Cross are working with volunteers to counsel those forced
to migrate out of rural areas affected by ash fall and who have so far
received very little humanitarian aid.
SUMA
Due to governmental reorganization, SUMA equipment is being trans
ferred from the Housing Department to the Civil Defense, where the emer
gency situation is now being managed. A new coordinator is being trained
in the role and operations of SUMA.
Water and sanitation
Nearly 80% of the drinking water systems located in the ash fall risk
zone of both volcanoes have been covered with protective plastic. In some
rural water systems alternative methods have been implemented using natu
ral materials to cover water sources and systems. The same affected com
munities have received training and materials for disinfection of water
supplies.
On April 6-7, PAHO’s Office in Barbados held a
seminar on post-disaster environmental manage
ment to define the roles of each country’s environ
mental sanitation program in disaster situations, in
terms of vector control and water and food sanitation. Participants also looked at PAHO’s role in
assisting in the transparent management of inter^
national donations and aid.
Representatives attended the seminar from
Anguilla, Antigua and Barbuda, Barbados, BVI,
Dominica, Grenada, Guyana,
Puerto Rico, St. Christopher
and Nevis, St. Lucia, St.
Vincent and the Grenadines
and the U.S. Virgin Islands.
Support for the meeting was
also provided by the Centers
for Disease Control (CDC),
which in the past few years
has been involved in post-hur
ricane environmental evalua
tions in the United States.
Contact: vanalphd@paho.cpc.org.
FAHUM Civilian-Military
Meeting
■
From 14-26 February 2000 a civilan-military
meeting funded by the US Southern Command
was organized in Santo Domingo, Dominican
Republic. Over 500 persons from Latin America
and the Caribbean participated, as well as US mil
itary. The objectives were to enhance coordination
of international, governmental and non-govern
mental agency relief operations during disasters
and to promote civilian-military cooperation.
During the first week the Office of U.S. Foreign
Disaster Assistance (OFDA) conducted a work
shop on damage assessment, needs analysis and
emergency operation center management. A desk
top simulation exercise tested the different coun
tries' EOC disaster plans. Disease surveillance,
water and sanitation vector control and mass casu
alty management were included in the response
scenario.
(cont. on page 5)
4
Disasters: Preparedness and Mitigation in the Americas • April 2000
No. 1
A Supplement to Disasters: Preparedness and Mitigation in the Americas
April 2000
the quarterly newsletter of PAHO/WHO
PAHOMHO
Disaster Motigatioim Goa!§ m the Americas:
More important than Ever
'Much has been written about the importance of incorporating disaster mitigation measures into the design, construction and mainte
nance of our most critical facilities, such as hospitals. Nonetheless, despite the reminder left by extremely severe disasters in recent
years, much remains to be accomplished if these facilities are to be fully operational in the aftermath of emergencies.
ith just one year left before the deadline set at the
International Conference on Mitigation of Natural
Disasters in Health Care Facilities, held in Mexico in
1996, meeting national goals is more important than ever.
The disasters throughout the Hemisphere in recent years—
among them hurricanes Georges and Mitch and the floods in
Venezuela, emphasized the vulnerability of health facilities and
how necessary mitigation measures are to keep them operating
when disaster strikes.
Specifically, at the International Conference in Mexico, 500
experts outlined a series of recommendations for the period
1996-2001 to improve or initiate efforts to promote disaster miti
gation in health facilities in countries at risk of hurricanes and
earthquakes. Today, it would be necessary to add floods and
landslides to the list of hazards.
One of the key recommendations was that each country identi
fy its highest priority health facilities to conduct vulnerability
W
studies and adopt the necessary mitigation measures. Another
important recommendation, in fact, was to conduct structural
vulnerability studies and draw up plans to reinforce priority facil
ities, employing suitable procedures consistent with current tech
nical know-how.
Another key recommendation was to consider geological and
meteorological threats, such as floods and landslides, when plan
ning health services and to include mitigation measures in the
design and construction of new health facilities or the remodel
ing and expansion of existing ones.
Some countries have made progress toward meeting these and
other goals, as seen in the examples that are included in this spe
cial supplement on the work under way in Colombia, Argentina,
Chile, and the Caribbean. However, many tasks are still pending,
and the work on disaster mitigation in Latin American health
facilities is just beginning, although some concrete results are
already visible.
S-1
Colombia Readies Hospitals Against Seismic Risk
Santafe de Bogota has Invested in Vulnerability Studies and
Reinforcement of Public Hospitals
he Secretariat of Health of Bogotd has invested almost 27% in second-level (intermediate-complexity) facilities, and the
US$500,000 over the past three years in a vulnerability remaining 15% in first-level (low-complexity) facilities.
The vulnerability studies and
assessment of 16 public
retrofitting designs for secondhospitals in the Colombian cap
Public Hospitals Assessed in Bogota
and third-level hospitals have
ital. The funds for this opera
already been completed, cover
tion have been drawn from city
Date
of
the
Hospital
Level of
ing
almost
83%
of
hospital
resources, given the importance
Assessment
Complexity
beds.
of guaranteeing that health
1996
Kennedy
111
In addition, assessments of
facilities continue to provide
Dec.
97
Simon Bolivar
the nonstructural and functional
services when disasters strike.
Dec. 97
Tunal
vulnerability of third-level hos
Dec. 97
La Victoria
With the vulnerability study
Dec. 98
Santa Clara
pitals have already begun. This
almost complete, retrofitting
Dec. 97
will help to further mitigate thq^
St. Blas
II
has begun on the Kennedy
Dec. 98
Meissen
risk faced by Colombian health
Hospital, one of the larger,
Dec. 98
Carmen
facilities in natural disasters.
more complex facilities. Work
Dec. 98
Fontibon
Bogota faces an intermediate
on four more facilities of lower
Dec. 98
Guavio
seismic risk and, in 1997 new
Dec. 98
Granja
complexity will follow.
Dec. 98
Bosa
legislation was passed that
Approximately USS 4.5 million
Feb. 99
Olaya
1
increased the mitigation
has been invested in the
Feb. 99
Tunjuelito
requirements for facilities that,
Kennedy Hospital, and close to
Feb. 99
Usme
like hospitals, must remain
USS 200,000 earmarked for the
Chapinero
Feb. 99
open when a disaster strikes.
four remaining hospitals. The
studies and retrofitting activities,
For more information contact Dr. Carlos Roberto Garzon Becerra, Fax:
constitute an investment of more than USS 5 million.
(57-1) 348-0097; e-mail: aemurdes(8)colomsaLnet.co.
To date, Bogota’s public hospital system has nearly 1,900
beds, 58% of them in third-level (high-complexity) facilities,
Caribbean Hospital Doubly Affected by
Hurricanes Rebuilt
was successfully completed, and what was once a vulnerable
hospital, today is a structure with the highest standards of resis
tance to hurricanes and earthquakes.
0
90% of St. Kitts Hospital Damaged by Hurricane Georges
Other Caribbean Hands
In the past decade, two major hurricanes have caused severe
damage to the Joseph N. France General Hospital: Luis in 1995
and Georges in 1998. Georges, a category HI storm, struck Saint
Kitts and Nevis with winds of more than 115 km/hr.
In the aftermath, 90% of the J.N. France Hospital suffered
major damage and was out of commission. The majority of the
structure had no roof, and even though all the windows had been
boarded up as protection against the winds, the impact was criti
cal. Even the roofing installed after Hurricane Luis was lost.
In a few hours Georges had virtually destroyed the only refer
ral hospital on the island of St Kitts, which served a •itpulation
of 33, mu Given the urgent need to rehabilitate the hospital,
PAHO launched a rehabilitation project, with financial support
from the European Community Humanitarian Office (ECHO),
the United Kingdom’s Department for International
Development, and the Government of the Netherlands. The
assistance enabled the government to rebuild critically damaged
areas and departments. By September 1999 the reconstruction
In addition, under a second ECHO project, vulnerability stud
ies of hospitals are being conducted on other Caribbean islands
to reinforce selected buildings. A study of this type is currently
underway in Saint Lucia and Grenada and will end in June of
this year with two workshops on mitigation to disseminate the
guidelines prepared by the ECHO project.
Based on this experience, a technical document, “Mitigation of
Natural Disasters in Health Facilities-Guidelines for
Vulnerability Analysis,” will be prepared by professionals based
on the experiences of the Caribbean countries and geared to hos
pital administrators and other health professionals in the
Caribbean. These guidelines will indicate how to conduct prelim
inary assessments of vulnerability to earthquakes and hurricanes
in the respective departments. They will also provide profession
als with tools for their negotiations with technical staff and for
setting priorities in the rehabilitation of their units.
Contact Dr. David Taylor, fax: (1-246) 436-9779; e-mail:
taylorda@cpc.paho.org.
■■
S-2
■
— —
-
—
_
...
-
_
Disasters: Preparedness and Mitigation in the Americas • January 2000* Supplement
Health Network Collapses in Worst Affected Areas of Venezuela
F* H ^he worst disaster in Venezuelan history struck last mud, requiring relocation and reconstruction. Three more hospi
11 December, sparing very little in its path. The Maternal tals suffered major damage and require very costly repairs, while
and Child Hospital of Macuto was partially buried under the 32 remaining facilities also suffered minor damages (see
the rocks and mud swept down
box).
by landslides from the Cerro
The magnitude of the dam
Damaged Health Facilities
Avila on Venezuela's central
age was such that, according
Vargas, Venezuela
coast following torrential rains.
Venezuela's Ministry of Health
However, this children's hos DESTROYED. MUST BE RELOCATED OR REBUILT
and Social Development, reha
pital was only one of the 43
bilitating the entire network of
Six outpatient facilities
One maternal and child hospital (will become general hospital)
health facilities that were left
health facilities in the State of
One psychiatric hospital
out of commission in the State
Vargas alone will cost nearly
of Vargas, where the most SEVERE DAMAGE. REQUIRES MAJOR REPAIRS
USS 44 million. Of this invest
ment, 64% will go to replacing
damage occurred, revealing the
One type 3 hospital*
buildings and the remaining
vulnerability of these facilities
Two type 2 hospitalss
35% to equipment and the
to disasters and the importance
development of a modem trans
l|f preparing in every possible REQUIRE MINOR REPAIRS
30 type 1 outpatient facilities
portation and communications
way tolessen this vulnerability.
One Childrens and Adolescents Hospital
network.
Some health centers were
One Geriatric facility
Almost half the total invest
irreparably damaged, totally
ment will be for new infrastruc
buried by the avalanche; others • The level of complexity of health facilities in Venezuela is classified from Type 4
ture—for example, the con
suffered serious damage, and (most complex to Type I (least complex).
Source: Ministry of Health and Social Development
struction of a 120-bed hospital
the remainder, a degree of dam
to replace the Maternal and
age that also kept them out of
commission for several hours, days, or even weeks. In some Child Hospital of Macuto, 45 comprehensive care units, which
health facilities, the infrastructure was not damaged, but they serve as the population’s point of entry to the new model of care;
were unable to operate because basic services such as water and six urban outpatient facilities; and a regional psychiatric hospital
electricity were interrupted, or because access to the facility was with 200 beds. This investment represents an opportunity to
blocked. This heightened the impact of the disaster, leaving the reduce the vulnerability not only of health facilities but of the
injured and other survivors without a health center to provide entire health services network of the State of Vargas.
immediate attention.
For more information, contact Dr. Jorge Prosperi, Tel: (56-2)
Six outpatient facilities (out of a total of 36) and the Maternal
2671622 Fax: (56-2) 2616069 E-mail: prosperi@ven.ops-oms.org.
and Child Hospital were either totally or partially buried by the
^afe Hospitals throughout Chile
Sustained Effort to Mitigate Hospital
Vulnerability to Earthquakes and Fire
From Arica at the northern tip of the country to Puerto Montt
in the South, the Chilean Ministry of Health has identified hospi
tal buildings most vulnerable to earthquakes and/or fires.
The assessments, which began seven years ago, determined the
vulnerability of 14 hospitals and disaster mitigation measures
were defined. The studies revealed that the hospitals' weak
points are related to both structural and nonstructural factors.
These weak points were uncovered, for example, in the case of
the Coquimbo Hospital, when the pillars and beams of its lower
floors were damaged in an earthquake in 1997. After the respec
tive vulnerability study, the structure was reinforced by con
structing 33 new walls to minimize the impact of an earthquake
on the building. An important point is that constructing these
walls is part of a series of expansions programmed as part of the
normalization of the hospital, demonstrating that not only is it
feasible and highly profitable to include mitigation measures
when expanding health facilities, it is also a good solution.
Models and Standards, a Good Outcome
Chile’s mitigation efforts will continue in 2000 and 2001 with
a series of studies to develop an “Analytical Model for the will
include a study of structural and nonstructural aspects of hospi
tals, ranging from the local geology to topography, soil mechan
ics, and microvibration of the structures.
Plans are also afoot to set standards for the design of new hos
pitals, permitting them to withstand earthquakes and remain
operational. Meanwhile, in the buildings currently planned, a
series of new requirements have been introduced to make struc
tures more earthquake-resistant.
Other important actions include the creation of a laboratory to
determine the seismic vulnerability of medical equipment, and
the recent publication of the “Manual on Fire Prevention in
Health Facilities” that will be soon be posted on the Ministry of
Health website (www.minsal.cl).
For further information, contact Ing. Agustin Gallardo, e-mail:
gallard(a)pasteur.minsal.cl.
Disasters: Preparedness and Mitigation in the Americas • January 2000• Supplement
(corn. on page S-4)
S-3
Argentina Also Evaluates the Vulnerability
of Hospitals in San Juan Province
Public Health Centers Located in High Seismic
Risk Areas
Western Argentina is a seismically active region with several
provinces: San Juan, Mendoza, Salta, and Jujuy. This area has
been hit by destructive earthquakes for the past 300 years, and
San Juan and Mendoza were the sites of real regional disasters
after the earthquakes of 1944 and 1961, respectively.
Nine of the 13 health centers and public hospitals of San Juan
are located in Area 4 (very high seismic risk), and the four
remaining centers in Area 3 (high risk). Together, these centers
have 1,157 beds serving almost 600,000 inhabitants.
For this reason the National University of San Juan decided to
launch a research project known as “Preliminary Assessment and
Reduction of Seismic Vulnerability in the Public Hospital
Network of San Juan Province,” scheduled for 2000 and 2001
and sponsored by the School of Architecture, Urban Planning,
and Design.
The project is subsidized by the University, but also has the
endorsement and patronage of the Health Program for Disaster
Prevention of the Secretariat of State and Public Health of San
Juan, as well as technical support from PAHO/WHO.
The study will include a structural, nonstructural, and func
tional assessment of the health centers that will permit the design
of measures to reduce its seismic vulnerability. This will be a
very complete study with four interrelated phases.
The first phase involves the collection and systematization of
background information on the damage that earthquakes produce
in hospitals, an estimate of the seismic risk in San Juan and at the
sites where its health centers are located, the damage produced
by historical earthquakes in the hospitals of San Juan and neigh
boring areas, and soil characteristics in the area in which each
hospital is located.
The second phase will consist of the compilation and recon
struction of the information needed for the assessment (from
technical documentation to photographs), and the third, of a pre
liminary vulnerability assessment of each hospital, which implies
the classification and prioritization of each in terms of the esti
mated level of risk, the complexity of the hospital, and the popu
lation served.
9
The study will conclude with a fourth assessment phase and a
list of the necessary mitigation activities for each hospital to ori
ent actions in the short, medium, and long term.
For further information, contact Virginia Rodnguez, e-mail:
deskjet(5) impsatl.com.ar.
Excellence in Disaster Mitigation
The PAHO/WHO Collaborating Center on Disaster
Mitigation in Health Facilities created just two years ago and
located in the University of Chile’s School of Physical and
Mathematical Sciences has already provided important techni
cal assistance in Argentina, Bolivia, Chile, Ecuador, Peru, and
even Nepal, in Asia.
The Center has devoted itself to providing assistance in areas
such as vulnerability assessment, the design of mitigation
strategies, the rehabilitation of hospitals and health systems,
training and the development of instructional and technical
materials.
This effort brings together and coordinates professionals and
technical personnel from other institutions and countries and
currently employs the expertise of specialists in the assessment
of seismic, hydrologic, and meteorological risk. One of the
special features of the Center is precisely that it is an open
institution that invites professionals with demonstrable experi
ence to participate.
Experience in the Field
The Collaborating Center on Disaster Mitigation in Health
Facilities has provided emergency technical assistance in iden
tifying and quantifying damages and defining strategies for
rehabilitation in the hospitals of Bahia Caraquez in Ecuador,
Aiquile in Bolivia, and Region Four in Chile. It has also con
S-4
ducted vulnerability studies in Chile in the Coquimbo and
Copiapo hospitals.
Reviewing national risk reduction programs in existing
structures and designing strategies for new systems has been
another aspect of the Center’s advisory services. Work in this
area has been done in Argentina, Chile, Ecuador, Peru, and
Nepal.
How to Assess the Vulnerability of a Hospital
One valuable contribution of the PAHO/WHO Collaborating
Center will be a document, “Methodology for Hospital
Vulnerability Assessment”, detailing the theory behind the
methodology and its application.
The document will be accompanied by the specific example
of Hospital of Arica, located in northern Chile, a region hit by
several earthquakes of a magnitude higher than 7.5 on the
Richter scale and two tidal waves in the past century. The hos
pital that was assessed had been damaged by a 6.7 magnitude
earthquake and had already been repaired. The document
details the steps of the vulnerability assessment, from the
objectives and background to the expected results, the duration
of the activities, and the professionals required. The publica
tion
will be ready by mid-year. -- --------- —---- —------ —---- -—
----------------------------------Contact RubSn Boroschek, Tel: (56-2) 6784372 Fax: (56-2) 689 2833;
e-mail: rborosch(5)cec.uchile.cl.
Disasters: Preparedness and Mitigation in the Americas • January 2000 • Supplement
This exercise increased awareness of available
resources in the region and international assis
tance. The concept of a Humanitarian
Coordination Center, staffed by representatives of
foreign military and civilian agencies but linked to
the National EOC, was discussed exhaustively.
Contact: vanalphd@paho.cpc.org.
Andean Region Web Workshop
During the week of 17 April, PAHO held a
workshop in Ecuador on the importance of the
totemet and in particular, websites, for disaster
Ristitutions such as the Red Cross, health depart
ments, Civil Defense and NGOs. The workshop
facilitated inter-institutional communication and
exchange of information, particularly in identify
ing institutions with webpages and those that
required assistance in their web development. This
pilot workshop will be the beginning of a series of
workshops involving Andean countries on topics
ranging from basic Internet skills training to pro
gramming and web development issues. For fur
ther information contact sbootsma@ecu.opsoms.org.
SUMA Integrated into Regional
Disaster Mechanisms
The Humanitarian Supply Management System
(SUMA), now widely used and accepted in Latin
JKmerica, is increasingly becoming integrated into
the disaster response mechanisms of the countries
in the Region. Here, and in other parts of the
world, its utility as a supply management tool and
as an indicator of transparency and accountability
is increasing.
• In Costa Rica, the Water and Sewage Authority
(ICAA) is evaluating the potential use of
SUMA in warehouses during disasters, as well
as for routine operations, due to its quick instal
lation and low training requirements.
• The Red Cross in Costa Rica, in conjunction
with FUNDESUMA, is organizing a workshop
to evaluate the SUMA Instructor Manuals
• A SUMA Module will be given as part of the
Disaster Prevention and Management Course at
the Technical University of Pereira, Colombia,
and the local Municipality of Pereira will con
duct an evaluation of incorporating SUMA into
the local emergency response mechanism.
• SUMA will host a seminar on Humanitarian
Supply Management at the World Association
for Disaster and Emergency Medicine in
Mexico at the end of May.
For further information on SUMA, please visit
www.disaster.info.desastres.net/SUMA/ or e-mail:
funsuma@sol.racsa.co.cr,
The New 'Electronic' CRID
CKD&ttTT'-IIQD
The Regional Disaster
Information
Center
(CRID) has just undergone
a makeover as it continues
to grow on the Internet. In
response to user requests,
CRID’s newly designed
web site features an easierto-navigate interface for
locating critical disaster
information and accessing
D
other services more quick
ly. The new site, which is
compatible with all Internet browsers, features the
following sections:
• Home page. Here, CRID will announce news
and services and provide the gateway for
searching the Desastres database and the Virtual
Disaster Library (more than 250 full-text docu
ments, as described in the previous issue of this
newsletter). The home page also has links to the
web sites of CRID’s partners.
• A description of CRID, offering a brief history
of the Center and its functions, as well as basic
information on how to request services.
• Information tools. Describes the databases,
information sources and the disaster thesaurus
that CRID is using.
• Training material. Offers basic concepts of vul
nerability, hazards and risk, guidelines on what
to do in different types of disasters and manuals
on a variety of topics, including how to estab
lish a disaster information center.
• Latin America and the Caribbean. Basic data on
the region and a list of institutions active in dis
asters in each country.
• Regional Disaster Information System. Updates
on the status of the System, agreements that
have signed and progress made in a standard
ized thesaurus, all which is being coordinated
by CRID.
• Related sites. Pointers to other sites that deal
with disasters.
Disasters: Preparedness and Mitigation in the Americas • April 2000
+< 0
O C3
Visit the CRID at
www.crid.or.cr, or
at its mirror site
www. crid.
desastres.net.
5
evoew of
New Disaster Chronicle on E!
Nino
Now that we are between El Ninos, this is a
good opportunity to collect and learn from the
experiences of the last phenomenon in 1997-98.
With just that purpose in mind, PAHO/WHO has
published a new book in its Disaster Chronicles
series that looks back, both technically and
k institutionally, at the health sector’s involvement in this disaster to help avoid repeating
the mistakes of the past.
This publication is available in Spanish
only. It will soon be on our web site at
www,paho.org/english/ped/pedsren.htm.
Natural Disasters: Protecting the Public's Health
Helping to reducing the impact of disasters
where it most counts
atural disasters remain a very real threat to the
health and well-being of the population of the
Americas. We need only to recall Hurricanes
Georges and Mitch, or the December 1999 flooding in
Venezuela. This new PAHO publication is intended to
help reduce the consequences of disasters on health.
The first edition of this book was published in
1981 for staff in charge of providing health services
after natural disasters. Back then, few questioned
who was in charge of preparedness and mitigation.
Today, things have changed, and fortunately society’s
interest and participation both precedes and extends beyond the actu
al disaster response phase. Today there is a much greater recognition of the
interdependence between disasters and development: on the one hand that
disasters set back development, and on the other hand, that the road to
development can increase vulnerability and the destructive consequences of
natural phenomena.
This new book reflects this perspective and describes, in general terms,
what the health sector can do to reduce the impact of disasters on the health
of their population.
For the most part, this publication is directed toward health sector profes
sionals involved in disaster preparedness, response or mitigation. However,
with today’s intersectoral focus on disaster reduction, it also provides a
basic framework for all disaster professionals interested in health issues.
Public health professors and students may find the publication useful as a
basic manual.
To order a copy, send a fax: (301) 206-9789 or e-mail: paho@pmds.com,
or to request more information visit PAHO’s Library on the Internet at:
http://publications.paho.org.
6
o b D n cat i odds
A Different Approach to Ei Nino
The Marginalization of Disaster
Response Institutions: The 19971998 El Nino Experience in Peru,
Boliva and Ecuador has been pro
duced by a group of experts, under
the coordination of Richard S. ■/
Olson, and published by the
/
Natural Hazards Research and
Applications Information Center
at the University of Colorado, USA.
This publication goes beyond examining ttf
lessons learned from the El Nino to include those
not learned. It focuses on the most recent conse
quences of EI Nino (ENSO) and the governmen
tal-institutional response in Peru, Bolivia and
Ecuador. It also evaluates institutional prepared
ness for the next ENSO. One of the study’s con
clusions is that “official” civil defense organiza
tions in the affected countries were rapidly pushed
aside, or marginalized, by new governmental
organizations that were temporarily created to
manage the response. The study also analyzes how
1997-98 ENSO became an important topic for the
media and for each country’s policy matters. This
document is available in full text on the CRID
web site (see page 8). Click on “News.”
New Publication on Health and
Environment
La Salud y el Ambiente en el /
Desarrollo Sostenible is an up-to- C-’t-
date assessment of the impact of
environmental hazards on health
at local, national, and global
levels. Health and environment
trends are analysed from the
1970s onward and also used as the
basis for projections. Additionally, by describing
how a sound environment can support or “enable”
health, La Salud y el Ambiente demonstrates that
environmental quality is crucial to human well
being. Finally, the report demonstrates how inte
grated health and environment policies and
actions are making significant contributions to
sustainable development efforts.
To order a copy, send a fax: (301) 206-9789 or
e-mail: paho@pmds.com, or to request more
information visit PAHO’s Library on the Internet
at: http://publications.paho.org.
Disasters: Preparedness and Mitigation in the Americas • April 2000
Why identify disaster victims?
(from page 1)
The disposal of dead human bodies obeys a
variety of sacred religious principles and tradi
tions: immediate burial before sunset for Muslims;
burial after one night of mourning in the Jewish
religion; and burial after three days for the
Catholic and Orthodox faiths. This array of cus
toms—across cultures and religions—confirms
that respect for the dead is both universal and
indivisible.
In that sense, it is appropriate that the identifi
cation and proper disposal of a dead body be
hanked to international human rights instruments,
as human rights are by nature universal and indi
visible across cultures, traditions, and customs.
Whether there needs to be a legal international
instrument that spells out this obligation is cer
tainly an important part of this discussion.
Currently, none of the basic international human
rights documents, beginning with the International
Bill of Rights has any direct reference to an obli
gation for appropriate identification and disposal
of dead bodies.
It is worth noting, however that, the U.N.’s
“Guiding Principles on Internal Displacement”
took more care to spell out recommended treat
ment of the dead. These guidelines, though not
legally binding, include reference to, inter-alia: the
relatives’ right to know the fate of missing; the
duty to investigate and to inform next of kin on
the progress of the investigation; the need to col
let, identify and prevent degradation of corpus to
allow for next of kin to respectfully dispose of
remains; and to protect grave sites of internally
displaced persons.
While the “Guidelines” are encouraging, none
of the older international human rights treaties
reflect a codification of this more advanced under
standing of the importance to family members and
the community at large of a dignified and proper
disposal of the remains of dead. Steps need to be
taken to make sure that jurisprudence, interpreta
tion of treaties and international customary laws
properly support decision-makers in humanitarian
crises. It is worth noting that further legal analysis
of human rights instruments could also help clari
fy that, so long as there is no real public health
concern, the failure of governments to properly
account for the dead in disaster situations is incon
sistent with many basic obligations under custom
ary and conventional human rights law.
During the days which followed the devastating
August 1999 earthquake in
Turkey, the press gave rise to
speculations by warning
Relatives of those
missing in the
1985 earthquake
“explosive epidemics of dangerous communicable
diseases were imminent due to the presence of
cadavers in the affected areas." This was enough
to trigger a campaign of mass burial, depriving
thousands of families of their right to know some
thing about their missing relatives.
The press, public health professionals and deci
sion-makers in the public sector each bear some
responsibility for this unnecessary blow to human
dignity and individual and collective human
rights.
It is urgent to stop propagating disaster myths
and obtain global consensus on the fact that
appropriate management of dead bodies following
natural disasters is a matter of collective mental
well-being, a question of ethics and human digni
ty, and rarely a means of avoiding diseases.
It is the responsibility of international organiza
tions—health and non-health—to put this issue on
their human rights agenda and create the forum
for such discussions regionally and globally.
Although the Universal Declaration of Human
Rights, the guiding document of human rights
principles, is silent on the issue of identification
and appropriate disposal of the dead, the same
document is entirely framed under the inalienable
principle of human dignity and therefore cannot
be ignored in making this claim.
PAHO/WHO acknowledges the contribution of
Dr. Michel Thieren, WHO/EHA and Mr. Robert Cuitteau,
Executive Director, Center for Human Rights, American University.
This editorial is an abstract of their collaborative effort (full
text available on request from the Editor).
Disasters: Preparedness and Mitigation in the Americas • April 2000
in Mexico anxious
ly wait to hear
something about
the fate of loved
ones. Meanwhile,
the city's baseball
stadium served as
a makeshift
morgue. Proper
identification of
the dead is more
than a legal need,
it is a human need.
nograp oy
The articles listed in this section may be of interest to health professionals and others
responsible for disaster preparedness, mitigation and relief. They have been repro
duced and recently added to the collection of articles available from the Editor of this
Newsletter. A complete list of reprints is available upon request. Please quote the ref
erence code listed to the left of the publication title when requesting articles.
Slowing Umana, Karin, “Impacto de los desastres naturales en el
desarrollo urbano y la salud publica en Centro America y el Caribe,
salud y proceso de urbanizacion on la ciudad de Guatemala,”
Institute Centro Americano de la Salud.
Chaves Quintana, Pablo, “La integracion y preparacion de la medicina veterinaria para actuar en situaciones de desastres naturales,”
paper presented at the XVI Pan American Congress of Veterinary
Sciences, 9-13 November 1998.
Quarantelli, E.L., “Disaster related social behavior: Summary of 50
years of research findings,” University of Delaware, Disaster
Research Center, Preliminary Paper #280, 1999.
Chaverri Soto, Milton et al., “Alojamientos temporales Municipio
de Calarca - Quindio, Colombia,” Pan American Health
Organization, June, 1999.
Noel, Gloria E., “The role of women in health-related aspects of
emergency management: A Caribbean perspective”, The Gendered
Terrain of Disaster: Through Women s Eyes, Westport, Conn., pp.
213-223.
Baxter, Peter et al., “Difusion: Actividades,” Revista Prevention,
No. 18, May-Aug. 1997.
Disasters: Preparedness and Mitigation in the
Americas is the Newsletter of the Emergency
Preparedness and Disaster Relief Coordination
Program of the Pan American Health Organization,
Regional Office for the Americas of the World Health
Organization. The reported events, activities and pro
grams do not imply endorsement by PAHO/WHO,
nor do the statements made necessarily represent the
policy of the Organization. The publication of this
Newsletter has been made possible through the finan
cial support of the International Humanitarian
Assistance Division of the Canadian International
Development Agency (IHA/CIDA), the Office of v
Foreign Disaster Assistance of the U.S. Agency for
International Development (OFDA/AID), and the
Department for International Development of the U.K.
Correspondence and inquiries should be addressed
to:
The Editor
Disasters: Preparedness and Mitigation
in the Americas
Pan American Health Organization
525 Twenty-third Street, N.W.
Washington, D.C. 20037, U.S.A.
Tel: 202-974-3522 • Fax; 202-775-4578
E-mail: disaster-newsletter@paho.org
www.paho.org/english/ped/pedhome.htm
CRID
Regional Disaster Information Center
Apdo. 3745-1000, San Jose, Costa Rica
Fax:(506)231-5973
E-mail: crid@crid.or.cr
www.disaster.info.desastres/net/CRID
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CONTENTS
S . No 4
1
I TEWS
.
INTRODUCTION
‘
2*
OF
TYPES
NATURAL
Major
THE
4,
IMPACT
5.
NATIONAL
i)
ii)
Calami
CENTRAL
OF
OF
CALAMITIES
Minor
and
ROLE
3.
6.
PARA
ties
2.1
1
2.2
1
to
3.6
CALAMITIES
3
5 j
POLICY
Relief
Primary
Secondary
Functions
Relief
1
3
4-5
5
5.3.2.1
Functions
5.3.2.2
DIVISION
<
i)
Action
Pattern
6.2
6-7
6,3.1
P
iv)
Inter
Relief
Ljty
•
Commissioner
4
<
*
6.3.2
Room
Control
Officer's
functions
6.3.3
c
V-
8
v)
Con tr o I
R oom
Equi pinc
6.3.4
vi)
Control
Room
responsibilities
6.3.5
vii)
Dealing
with
First
6.3.6
viii)
Nodal
Designating
Information
6.4
Officer
1 0
:0
CABINET COMMITTEE
7.
CRISIS
NATIONAL
Mini s
for
10.
MANAGEMEN i
MANAGEMENT
CRISIS
Relief
Functions
FOR
EXTENDING
ASSISTANCE
COMM I
11 EE
ts
the
Monitoring
STATE
i)
RELIEF
State
10-U
10.1
of
Progress
12
Relief
10.2
ORGANISATION
Crisis
AND
Management
ii)
SCMG
ii)
State
Level
Con
trol
Room
iv)
State
level
Control
Room
-
9.3
FINANCIAL
Massures
.
to
Responsible
STATES
TO
10
9.1
GROUT
tr i es/Depar tmcn
PROCEDURE
RESPONSE
Group(SCMG)
11.1
1
1
1
3
.2
11.3.1
Responsibilities
11.4.1
Responsibili
11.4.2
14
12.1
1
12.2
15
12.4
15
12.6
15
13.1
15
ties.
12.
DISTuCT
LEVEL
i)
Point
ii)
iiii
iv)
13,
Focal
Contingency
District
RESPONSE
Plans
Relief
Committee
'I
Coordination
REVIEW
OF
NO.
2-3
RELIEF
iii)
1
1
SCARCITY
ii)
1
1
3.1
GOVERNMENT
PAGE
NO.
CONTINGENCY
PLAlJS
ANNEXURES
contents__________________
NUMBER
I
Economic
Natural
Calamities.
Statement
II
rel
tion
showing
to
the
‘"’atural
‘Minis trie s/De par
Ill
Health
£
Social,
consequences
response
required
Calamities.
tinon ts
responsible
for
•
Relief
functions
*
IV
-
A
Dis
tr i c
t
Con tingcncy
Plan
-
Earthquake
IV
-
B
Dis
trie t
Con tingency
Plan
-
C v c 1 on e
<
IV
-
C
Dis
trie
IV
-
D
Dis
tr ic t
t
tingency
P1 a n
-
Flood
Con tingcncy
Plan
-
Drought
Con
•
of
in
2
f
THE ROLE OF
CENTRAL
GOVERNMENT:
'3.1
Government's response, and efforts set the
pace and determine -the quality of a society’s
reaction to a crisis-situation resulting from a
natural calamity.
In the federal r.^t up of India,
the responsibility to formulate the Government’s
response to a natural calamity is essentially
that of the concerned State Government.
However,
the Central Government supplements, to the extent
possible, the efforts of the State Government by
way of providing financial and material assistance
for effective management of tin? situation, in
accordance with the existin'? scheme of flnancino
the relief expenditure.
DROUGHT:
3„2
Weather forecasting techniques and the
gradual setting in of the damaoo to agriculture
during drought afford sufficient response timetor meeting the exigencies of a drought situation.
The damage due to this calamity can be considera
bly mitigated with drought proofing and the
preparedness to initiate the required measures £
the first sign of failure of rains.
EAR THQUAKE:
3.3
As of today, there is i n warning system or
reliable method of prediction for the occur one ?
of earthquakes with respect to time and space.
However, scismclogically> e ^r thr- jake-pro? areas
could be identified allowing i f'i? lono-t.um pre
paredness like construction of quake resistant
structures and shelters as those help in miticati::
loss of life and property.
CYCLONES:
3.4
A two s tage cyclone w-arning sys- •' is
available in the country to trigger advance pre
cautionary measures in the face of cyclone threat.
The first star? cyclone alert is issued
i'o.ui
before the excreted commencement of th? adverseweather by the Cyclone V/arning Centre
to
the State Chief Secretary and the Collectors
the districts likely to be affected by this
*
calamity.
.repeated broadcasts on the radio and
T.V. are also r. ide to warn t-'o poop I~
the
impending calamity and of the measures required t.:
be taken by them., The second staoe numbered
cyclone warning bulletin from India Me- tear ol c-g i cal
Depar tment( It'D) commences 24 b.ours befcio the
expected landfall of the threatened cyclone.
FLOODS:
3. b
The Central Water Commission has also
established a warning system with a network of
147 flood forecasting stations on major inter
state rivers of the country.
Flood forecasts are
issued to various Sta tc. au theri tic-s to enable
them -to take;advance action to save life and
property.
••
•.* * *. ••‘ • r-’
MINOR
CALAMITIES:
3.6
-Minor calamities like hailstorms, avalan
ches, landslides and;fires also occur without any*
appreciable degree Fof forewarning and cause damage
to. properties and lives. However, areas prone to
such disasters also could be identified and certain
precautionary measures taken in the context of
potential threat requiring general awareness and
an ability to relate to a predefined system of
appropriate responses bn the part of the local
adminis tra tion.
IMPACT OF
CALAMITIES:
The social, economic and health consequences
of different types of disasters arc indicated in
Annexure-I.
NATIONAL
POLICY:
5.1
Traditionally, relief in the wake of natural
calamities‘has been treated as the primary respon
sibility of the States. Successive Finance
Commissions have also reiterated this position.
Even though the States are primarily responsible
for relief activities, the Central CioveriiK.-nt
associates itself with mon stives
a t ameliora
ting the sufferings of th.- pcepJo on account of
natural calamities.
Towards thin end, the Central
Government, with its resources, physical and
financial does provide the needed help and assis
tance to buttress relief efforts in the
of
major natural calamities.
The dimensions of the
rcsoon.se at the level of National G^v^rnr.ien t are
determined in accordance with the oris ting pul fey
of financing the relief expenditure and keeping
in view the factors like (i) the gravity of a
natural calamity, (ii) the scale of- the relief
operation necessary, and (iii) the r aquir--.mon tr. of
Central assistance for augmenting Lho financial
resources at the disposal of the St-^tc Government.
5.2
Types of Response:
<
The Central response can be:
5.2.1
(i)
Policy response, and
(ii)
Administrative response.
Policy response:
The policy response to a natural calamity
would be provided by the Prime Minister, Cabinet
Committees and the Agriculture Minister.
lho
objectives of policy response would be:
(a)
to empathise7 with the sufferings of the
people affected by natural calamity; and
(b)
' to' sub-serve’ Tong' term and short term
policy objectives of the Government.
4
».
. , 5.2>2 "■ Administrative response:
Thg response of
the. Administration to a situation arising out of a
. ‘ natural', calamity . can be on account of:
'" 3 follow-up of a policy objective of the
/.Government;
(i)
(ii) '
the need for an assessment of the situa
tion and for a central response;
(iii)
States1 requests for Central assistance;
and
(iv)
.. .
'
'
the. need for information as a governance
objective. * • -
5.3.1
. Central response: Central Government's
response / at the policy level, to a natural calamity
would lead to.Central initiatives in tie form.of:(i)
visits of the calamity affected areas by
President, Prime Minister and other
digni taries;.
(ii)
activating the. administrative machinery
for assisting in relief measures; and
(iii)
setting up a machinery for implementing,
reviewing and-monitoring of relief
measures.
5.3.2
The adminis trative response at tho Central
Government level would broadly relate to:~
(i)
operational requirements; and
(ii)
provision of Central assistance as per
existing policy.
The operational aspects of the administrative
response could, further, be classified into:-
PRIMARY
RELIEF
FUNCTIONS:
f. 1
------- . X. ;
(i)
Primary relief functions, and
(ii)
Secondary relief.functions.
5.3.2.1
The primary relief functions of the Central
Government-would relate to:
(i)
. forecasting and operation of warning
systems;
(ii)
maintenance of .uninterrupted communication;
(iii)
wide publicity to warnings of impending
calamity, disaster preparedness and relief
.measures through TV, AIR and Newspapers;
-1
'(iv).
SECONDARY
RELIEF
FUNCTIONS:
5 :
"transport with 1 particular reference to
evacuation and movement of essential
commodities and petroleum products;
(v)
ensuring availability of, essential
commodities at reasonable prices parti
cularly the commodities through the
Public Distribution System;
(vi)
ensuring availability of medicines,
vaccine and drugs;
(vii)
preservation and restoration of physical
communication links;
(viii)
investments in infrastructure; and
(lx)
mobilisation of financial resources.
5.3.2.2
The secondary functions of the Central
Government which supplement the States’ relief
efforts, would relate to:
flood/infiow forecasts from the Central
Water Commission;
relief, rehabilitation and restoration
through military aid to civil authorities;
contingency plans for crops, cattle
preservation nutrition and health
measures;
technical and technological inputs for
provision of drinking water;
technical assistance in the water budge
ting and water management for various
uses; and
(vi)
SCARCITY .
RELIEF.
DIVISION:
coordination of the activities of the
State agencies and voluntary agencies.
6.1
For ensuring appropriate policy and
acminis tra tive response to natural calamities, a
clear .identification of the nodal organisation
and the pattern of *inter-action between the
different Government functionaries would be
necessary.
The Department of Agriculture and
Cooperation(DAC) in the Agriculture Ministry is
tlie nodal Department for all matters concerning
natural calamities relief at the Centre.
In the
DAC, the Relief Commissioner functions at the
------nodal- officer, to coordinate relief operations for
»
6
all natural calamities.
The organisational set
up bf‘ Scarcity Relief Division of DAC is given
below:-
RELIEF COMMISSIONER
AND
ADDIT1OI4AL SECRETARY
ADDITIONAL RELIEF
COMMISSIONER AND
J PINT SECRETARY(SR)
DEPUTY SECRETARY(SR)
’UNDER SECRETARY
.ICOI4TRQL ROOM)
1------------------------- 1-------
UNDER StCRE 1ARY
(SCARCITY RELIEF)
"AssIstaHt
‘ TECHNICAL
DIRECTOR .
(MONITCRING)
OFFICER
(MONITCRING)
—.
SECIION
OFFICER
RESEARCH
11IVESTIGA JQR
INTER
ACTION
PATTERN:
I — II - I »•
■ ... ■■ <■>
.
SEC I ION
OFFICER
* — —
■
. i— - I -
RESEARCH
INVESTIGATOR
6.2
The Central Relief Commissioner would receive
information relating to forecast/warning of the
natural calamity from the Director General, India
Meteorological Department(IMD) or from the Central
Water Commission on a continuing basis and would
keep the Secretary(Agriculture & Cooperation) and
through him the Agriculture Minister and the
Cabinet Secretary and the Secretary to Prime
Minister and through them, the Prime Minister, the
Cabinet and the "National Crises Management
Committoe(NCMC)" informed.
Ho would, whenever
required, also disseminato • the information to
different Central Government Ministrios/Dcpartments
and the State Governments for appropriate .follow-up
action.
He would monitor the developments of the
9
t~7
situation on a continuing basis and would provide
the necessary feed-back, through the agriculture
Secretary, to the Agriculture Minister, Prime
Minister.and the Cabinet.
The pattern of inter
action amongst -the different authorities and
■ Governments in the context of o.ccurronce of a
natural calamities is depicted in- the following
diagram:—’
NATURAL -CALAMITIES - INTER-ACTION PATTERN
] NCM C _ _ —----------------------- V
CABINET
CABINET COMMITTEE
PRIME MINISTER
/ I
A. M.
m- 6 S
•
CAB.
SECY.
TO
P M
X
SECY.
•
X
IT
’ SECY(A&C)
7?
> DAC
(M/O Agri.,)
CENTRAL
MIN. IDEPTK/ORG
RELIEF.
COMMISSIONER
&
SCARCITY
RELIEF
DIVISION
STATES
UTs
.LEGEND
INFORMATION
INSIRUCTION/DIR ECTION
FEED BACK ..
I
.
r
■Iru
•
-w-w.
X
k —+ ■
-t -V -
■*** •
-
T-a it- . . '
c vTc
CONTROL
ROOM
RESPONSI—
BILITIES:
6.3.5
(i)
■’ ’ •
The Control
Room will:
*
•9 • •
‘
*
collect and transmit information concerning
a natural calamity and relief;
keep close contact with the Govts, of the
States affected by a calamity;
(iii)
DEALING
with first
INFORMATION:
interact with other Central Ministries/
Deptts. in connection with natural calami
ties and relief;
(iv)
maintain records containing ail relevant
information relating to action points and
contact points in Central Ministries/Deptts./
. . State Governments; and
(v)
perform such other functions and duties as
may be entrusted by the Relief Commissioner.
6.3«6
The Control Room on receipt of the first
information with regard to occurrence of any major
natural calamity will immediately transmit the
information to the following:Secretary to the President,
Secretary to the Prime Minister,
P.S. to Agriculture Minister,
P.S. to Minister of State(A£C),
Cabinet Secretary,
Secretary(A&C),
Secretary, Rural Development,
Secretary, Water Resources,
Secretary-, Power,
Secretary, Civil Supplies,
Secretary, Health,
Secretary, Communication,
Secretary, Surface Transport,
Secretary, Science & Technology,
Home Secretary,
Defence. Secretary,
Secretary, I&B <
Secretary(Food),
Relief Commissioner,
Joint SecretaryfScarcity Relief),
Joint Secretary(Policy Planning),
Agriculture Comnissioner, and
Animal Husbandry Commissioner.
The first information report and the sub
sequent periodical reports generated by the Control
Room will also be sent to the Officers indicated by
the Relief Commissioner^from time to time.
■
-
•
.
—•
10-" J —
'
-
.
•■■-■•
••••.;-.
’
.
.
•
/
.
i
-j-
;
i
• » •--
i
»
9
i
DESIGNATING
NOGAL
OFFICERS; ’
7a CABINET
COMMITTEE:
5< NATIONAL
CRISIS
MANAGEMENT
COMMITTEE
(NCMC):
,'
!
i
!
6.4
Every Minis try/De pertinent of Central Govt.
. dealing with the primary or the secondary relief
functions referred to in paras 5.3.2.1 and 5.3.2.2
above would designate an officer not below the
rank of- a Joint Secretary as the nodal Officer with
•an alternate for dealing with matters concerning
natural calamities and relief.
These nodal
officers shall furnish information to the Relief
Commissioner through the Control Room of the DAC
on such periodicity as may be determined by Relief
Commissioner.
’
For effective implementation of relief
measures in the wake of a natural calamity, the
Cabinet may set up a Committee. On the constitution
of such a committee of the Cabinet, the Agriculture
Secretary shall provide ail necessary information
to and seek directions if any, of tiie Cabinet
Committee in all matters concern! ng relief in the
<
wake of natural calamity and take steps for effective
implementation of its directions.
In the absence
of
such a Cabinet Committee, all matters relating
8)
7)
to relief shall be reported to the Cabinet Secretary.
6)
A National Crisis Management Committee(NCMC)
5) been constituted in the -Cabinet Secretariat.
has
The composition of the Committee is as undcr:41 ))
2)
3)
1
Cabinet Secretary
Secretary to Prime Minister
Score tary(M-HA)
Seer etary(MCD)
Director(IB)
SecretaryfR 8.AV/)
Seeretary(Agri. & Coopn.)
An officer of Cabinet
Secretariat.
Chairman
Member
Member
Member
Member
Member
Co-opted Member
Convenor
l
When a situation is to be handled also by the NCMC,
it will give such directions to the Crisis Management
Group of the Ministry as deemed necessary.
The
Seer e tary (A8.C) will be responsible for ensuring
that all developments are brought-to the notice of
the NCMC promptly..
•n CRISIS
MANAGEMENT
GROUP:
9.1
There shall be a Crisis Management Group(CMG)
for dealing with matters relating to relief in the
wake of. major natural calamities, consisting of the
following:-
(i)
(ii)
(iii)
Relief Commissioner
OSD, Cabinet Sectt. or a
representative of the
Cabinet Sectt.
A representative of P.M.O. *
Chairman
( iv) to('xiii)
f 1 • -‘
'
Joint Secretaries in the
Ministries/Deptts. of
Finance, Food, Civil Supplies,
Power, Urban Development,
Rural Development, Health,
Pteroleum, Planning Commission
and Deptt< of Women & Child Dev.
(xiv)
Director General, India. .
Meteorological Department.
‘
(xv)to(xvi)
Senior officers of the
Ministry of Railways/
Railway Board and
Mini s tr y of V/a ter
Resources.
(xvii) A senior officer from
the Ministry of
Comm.inica tions
(xviii) A senior officer from
the Minis try of
Transport dealing with
road communication
(xix)
Director General, Civil
Defence
(xx)
Joint Secretary,
Ministry of Defence.
(xxi)
x
5
0
[
jj
?
{
3
{
V
J
in the event
of a calamity
other than
drought.
Joint Secretary (SR ) & .
- Convener
Addl. Relief Commissioner *
The Resident Commissioners of the States
affected by major natural calamity may be coopted
on the CMG during the period of crisis.
9-2
The names, addresses of office and residence
telephone Nos. of all the members will be maintained
by the Scarcity Relief Division ano the Control Room.
•
CMG MEETINGS:
9.3
The CMG will meet atlenst twice in a year in
the months of December/January and May/June and as
often as may be required by the Relief Commissioner.
The CMG will meet in the chamber of Relief
Commissioner in Krishi Dhavan, New Delhi unless
otherwise indicated.
CMG RESPONSIBILITIES:
■ ’•
9.3.1
The CMG wili:-
(i)
review every year Contingency Plans formulated by the Central Minis tries/Depar tmen ts ;
(ii)
Review the measures required for dealing
with a natural calamity:
•
• 1
.12
0
MINISTRIES/
DEPARTMENTS
RESPONSIBLE
FOR RELIEF
FUNCTIONS:
1O.PRCCEDURE FOR
EXTENDING
r JUMMIVCIAL
ASSISTANCE TO
STATES:
I
M0N1TORIITG
THE PROGRESS
OF RELIEF
MEASURES:
(iii)
coordinate We activities of the Central
Ministries and the'State Governments in
relation to disaster prepayndnoss and
relief, and
(iv)
obtain information from the Nodal Officers
on measures relating to the above.
9.4
Details of the Central Minis tries/Departments/Organisations which are concerned with the,
primary and secondary relief functions for different
types of natural calamities, are indicated in
Annexure-III.
The nodal officer of each Ministry/
Department would be responsible for the formulation
of a Detailed Action Plan (DAP) clearly laying down
the channel apd manner of interaction, between
agencies engaged in these functions, details of
the contact points, and the specific measures and
time-frames for their implementation.
Th.? specific
action plan of individual Minis try/Depar tmen t shaflfe
be submitted to the Central Relief Commissioner.
The CMG will review these action plans every year
and get them updated from time to time.
The present scheme of financina the relief
expendture arising out of natural calamities has
come into force w.e.f, 1st April, 1990, consequent
upon the acceptance of the recom!ii?n'h timm of the
Ninth Finance Commission.
Under this scheme, a
Calamity Relief.Fund(CRF) is constituted for each
State with certain amount allocated to each State.
75% of this amount is to bo contributed i*y the
Central Government in four quarterly ins t ilmen ts
and We balance 25% is to be provided by the State
Governments from its own resources.
Following the
constitution of the CRF, it is the res rcr- ibil i ty
of the State Government to meet all oxor nditarc
arising out of the natural calami tics.
10.1
10.2
An Export Group han been can*: l i I •»I “d on the
recommendations of We Ninth Finance Commission to
monitor the relief work done, utilising rhe CRF.
Further, the State Level Cornni tteo( s) ^ro to keep
tho
Agriculture informed of the amount
of damage caused due to drought, floods ^tc. as well a
the broad details of relief measures undertaken by
them.
The Scarcity Relief Division, in the Depart
ment of Agriculture & Cooperation, has 1.'quested
the State Governments to furnish the prouioss of
relief measures in We prescribed proforma on
quarterly basis.
-: 13
Most of thq States have Relief Commissioners
11 . STATE RELIEF 11 <1 •
ORGANI SA IT ON who are in charge of the'relief measures in the wake
AND RESPONSE: of hatural calamities in. their respective States.
In the absence of the Relief Commissioner, the Chief
Secretary or an Officer nominated by him shall be in
overall charge of the relief operations in the
concerned State.- The effectiveness of communication
links with field agencies may be reviewed through
periodical excercises.
• STATE
CRISIS
MANAGEMENT
GROUP:
1 1.2
There will be a State Crisis Management
Group(SCMG) under the Chairmanship of Chief Secretary/
Relief Commissioner.
This Group will comprise of
Senior Officers from the Departments of Revenue/
Relief, Home, Civil Supplies, Power, Irrigation,
Water Supply, Panchayat (local self Government),
Agriculture, Forests, Rural Development, Health,
Planning, Public Works and Finance.
The Chief
Secretary/Relief Commissioner may also coopt on the
Group, depending upon the requirements of the situa
tion, one or more of the following persons:
Sub-Area Commandor/Station Commander
Station Commander of Air Force
Flag Officer Command-in-Chief
Chairman/Secrctary, Indian Red Cross,
State Branch
(v)
Representative of Meteorological Department
Ctficer-in-chargo, Cyclone Warning Centre,
CWC and Flood Forecasting Organisations.
(Vi)
General Manager, Railways of
concerned
General Manager,
the zone
Telephones
Chief General Manager,
Telecommunications
D.G< of State Police
Chief Engineer, Roads & Buildinos
Chief Engineer, Major Irrigation
Chisf Engineer, Panchayati Raj
Chief Engineer, Urban Water Supply
Chief Engineer, Rural Water Supply
Director of Agriculture
Director of Horticulture
(xvii)
Director of Medical Health Services
Director
of Animal
.
• •
• * Husbandry.
•
f. ’
Secretary of ; the State Electrieity Board
*
/-
s,
.
*
k (xx)
(xxi)
(xxii)
Secretary, Deptt. of Women & Child
Development.
P.H.E., Deptt./Water Supply and
Sewerage Board
Station Director-AIR/DDK
(xxiii) Chief Engineer,' Border Road Organisation
(xxiv)
Director, Civil Supplies
(xxv)
Regional Manager, Indian Oil Corporation
(xxvi)
Director, • Local Bodies.
STAG
RESPONSI
BILITIES:
11.3.1
The SCMG will take into consider a tion the
instructions and guidance received, from time to
time, from the Government of India and formulate
action plans for dealing with different natural
calamities.
The SCMG will also have the district
level plans for relief formulated by Collectors/
Deputy Commissioners.
STATE LEVEL
CONTROL
ROOM:
11.4.1
The Relief Commissioner of the Stat? shall
establish a Emergency Operation Centre(Control Room)
as soon as a disaster situation develops.
The
Control Room shall have all information relating to
the forecasting and warning of disaster, action
plans for implementation and details of contact
points and various concerned agencies.
It shall have
up-dated information about the Air Force, the Navy
and the Army for quick interaction in times of
emergencies-
STATE LEVEL
CONTROL
ROOM
RESPONSI
BILITIES:
11.4.2
The Control Room will be responsible for:-
(i)
-transmitting to the Central Relief Commissione
information as to the development of a crisis
situation as a result of natural disaster on
continue basis till the situation improves;^
(ii)
receiving instructions and communicating t(r
the appropriate agencies, for immediate
action;
collection and submission of information
relating to implementation of relief measures
to tine Central Relief Commissioner; and
keeping the State level authorities apprised
of the developments on a continuing basis.
12.DISTRICT
LEVEL
RESPONSE:
FOCAL.POINT L
12.1 ’
The collector ■ or ./Deputy Corrals sioner will be
' the ifocal point at. the_,dis trie t level for preparation
of .the.-district IcvGT.Lp'Idns and •'for directing, super
vising and raonitoringi^rdiicf measures for natural <
y calamities.
15
CONTINGENCY
PLANS:
-’'1242 ,
At the district level, the disaster relief
plans; shall provide for specific tasks and agencies
for their implementation in -respect of the areas*?given in Annexure 4A to 4D, iq relation to different
types; of calamities.
12.3
A contingency plan for the district for »
different disasters shall be drawn up by the
Collector/Deputy Commissioner and got approved by the
State Government.
The Col lec tor/Deputy Commissioner
should also coordinate and secure the input from the
local defence forces unit in preparation of the
contingency plans.
Those contingency plans must lay
down specific action points, key personnel and
contact points in relation to all aspects including,
in particular, the areas detailed in Annexure 4A to
4D.
DISTRICT
RELIEF
COMMITTEE:.
1 2.4
The relief measures shall.be reviewed by the
district level relief committee consisting of official
and non-official members including the local legisla
tors and the members of Parliament.
DISTRICT
CONTROL
12.5
In the wake of natural calamities, a Control
Room shall be set up in .the district for day to day
monitoring of the rescue and relief operations on a
continuing basis.
ROQtlJ____
I
COORDINATION:
12.6
The Collector shall maintain close liaison
with the Central Government authorities in the
districts, namely, Army, Air Force and U-nvy, Ministry
of Water Resources etc., who could supplement the
effort of tiie district administration in the rescue
and relief operations.
12.6.1
The Collector/Depu ty Commissioner shall take
all steps for enlistment of voluntary efforts and
channelising the non-Covernment organisations response
to natural calamities.
12.6.2
The Collector shall closely interact with
different implementation agencies and furnish informa
tion on. a daily basis to the State Relief Commissioner
on the implementation <~»f rescue and relief measures.
13.REVIEW-OF
CONTINGENCY
PLANS:
13.i
The district level contingency plans -nnd the
State Action Plans should be reviewed annually and
updated in the light of lessons learnt in dealing
with natural calamities from time to time. Copies
of the rGvised/updated contingency plans at State
and district level should also available in the
.
.16
k
ANNEXURE-I
SOCIAL T ECONOMIC & HEALTH CONSEQUENCES OF NATURAL CALAMITIES
CONSEQUENCES
S.NO«
2
_1_ _
EAR iHTUAKE
3
• •
NATURAL CALAMITIES
CYCLONE FLOOL
FIRE
4
5
3
• 1.
. Loss of life
X
X
X
X
' 2.
Injury
X
X
X
X
x
X
X
X
4.
5.
Loss of housing
• X
X
X
X
6.
Damaoe
to
—z
in frastruetore
X
X
X
X
Disruption of
communications
7.
8.
~
9.
10.
Disruption of'
transportr
Panic
•
Loo ting
~
~
~
-t
-
— —
—
—l
X
X
X
X
X
X
X
X
• •
>/
X
jk
1
X
X
X
I
x
•
Breakdown of social
order
X
X
12.
Short-term migrations
13.
Permanent migration
14. •
Loss of Industrial
production
X w
X
X
X
Loss of Business
X
X
X •
X
<
X
X
•
15.
0
-
X
*
1 1 .
• •
X
•
7
X
Epidemiological threat
•
Loss of croos
•
3.
drought/
FAMINE .
*
Dis tx'uption of
marketing• • systems
X
LEGEND:
DIRECT CONSEQUENCE
.
A
•
•
.A.,.........
SECONDARY CONSEQUENCE
X
X
•
X
ANNEXURE-II
17 :
STATEMENT SHOWING THE RESPONSE REQUIRED IN
RELATION TO. NATURAL CALAMITIES
! a:
tYpE Cf“REspoNsE
L
jo.
FcCaEiSed
FLASH
FLOODS
EAR TH CYCLO
OUAKES NE 8
FLOOD
4
3
2
5
drou CALAMITIES
ght
LIKE FIRE,
LANDSLIDES
AVALANCHES
ETC.
6
7
, Weather Forecasting/
/ , prediction
Receipt of warn? no
U7 Warning Dissemination
Alternate Communication
• 9< Evacuation
»;£ Search & Rescue
.7 Temporary sheltering__________
Disposal of coroses
Emergency Health care
zD<o Prevention of Epjcemics
11 6 Establishment of Relief
9 Camps(Food, shelter,
Drinking Wate:;)______
X
* yV
X
X
X
X
X
■ X
X
X
X
X
|2. Security
X
X
X
X
4
□ <>> Family reunification
X
X
X
X
Post-Disaster Salvage
Security
X
X
X
X_____
Firc-fichtinq
X
Rehabilitation (Crops,
.Cattle, Alternate houses)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
"X
X
k
.
i
■
I
X
X
X
X
X
X
X
X
X
X
X
-
<
___ _____
•
X
X
X
X
X
X
X
X
X
X
7^ Contingency Plans:-
i.
Crops(Seeds, Fertili
sers, Pesticides
Petroleum products,
Power)
Drinkina water
•
ili. Employment Generation
• ii.
iv< Public Distribution
Sys tern
X
•
•
X
X = Response required
X
X
V
✓v
X
-
'tyj Ay.'.-.
MINTSTHIES/DEPARTMENTS RESPONSIBLE•FOR RELIEF FUNCTIONS
S.NO.
RELIEF FUNCTIONS
(PRIMARY ANL SECONDARY)
Wll-TQUAKE
DISASTERS
CYC- FLOOD
LONE
■v
MINISTRIES/
drqught/
FIRSTAVALAN
CHES/
LANDS
LIDES
'I?!
ANNEXURE-HI
DEPARTMENT
RESPONSIBLE
FOR THE
RELIEF
FUNCTIONS
8 •— *—• • WW ■■ I
FAMINE
4
1 ”1
!l il
’ ■ 1”
2£;
PRIMARY
Forecasting and operation of warning
systems________________________________________ •
X
Provision of communication
3.
•
Wide publicity to disaster prepared
ness throuah AIR, TV___________________
1
“
■
X
Transport with particular reference
to movement of essential commodities
nr-d petroleum products
•Ensuring availability of essential
• « • »• ....., . ... ‘.commodities for price control(inclu
ding inputs)
Ensuring availability of medicines,
6;
drugs and vaccine (including first aid)
fiy
Preservation and restoration of
physical communication links
Investment of infrastructure
8.
J S1—u -__ -<
■ Mobilisation of resources
•
•
•
y
X
X
X
X
X
DOT--
X
X
MIB
•
X
X
X
X
• X
•
Flow of credit
•
W';
• ■•
•
’
DOS/MOR/MOP
•
1
• — • -• *.
•
X
X
X
X
X
X
X
X
X
X
X
X
X•
X
1
•
••
1
X.
■
dac/dcs/doe/
mop/moc>
X
••
•
•
X
X
•
mhfw
X
• •
1
X
X
X
X
••
• • ••
X
X
ewo •• M •—v —
X
mor-/dot/dost/
mud? '
DAC/MWR/'toP/ ■
MOR/MOP/PC/MEF
MOF
■■
I
1’0.
■ 4/ -
t
4,.
•
1•
IMD/C
X
.
‘R.il
MOF/DAC:n1..
X
__
t
• • •'
6
i
contd
on
next page
.
■’ J
J
•* .
..J '
... • •
r
19
AHMEXURE-III (contel.)
. ••
•
•
’ » • • 1 .• ’•
./•*.>
v/
• ,• •/Ji’h*
•
»
7
J-'
’
•
*
SECONDARY
•
*
*
•
ro
•
.
•
•
•
•
1
Rescuo/evacuation operations
3.
Relicf/rehabilitation/rostor ation
,A.
Contingency plans for ciops/cattlc
5.
.Contingency plans for health
•
\y
Flood/inflow forecasts
•
X
_ measures
and
CV/C/LiV/R
•
X
X
X
X
A
X
MOD/MHA/.V.HFW
X
X
DO'.’.'/DAC/Dlb/'rr1
MOT/mEF
1
•
X
X
X
X
X
/c
A
X
X
X
DAC/DOE/DC?/
MEr
X
MHF/DWOD
X
drd/mud •
X
MWR/M'JD/
DRD
*
•
n u tr i t i on
t
’>'6.
' . \ <’ A5?t.
- f-’
• ■ '•
- . •J .
, J ,• •
■'
■t .
• .Technical & Technological inpuls
■for provision of drinking water
.Technical assistance in the v/ater
1 7.
•
• budgeting, and water management
’ for- various uses
1 '■ -- - J:.8. • • . . Coordination of the activities, of
the State and voluntary agencies
f
f
•
X
•
•
•
•* •
.
Disaster preparedness of areas
9.
>
_____
t
I
t
*
•
•
•
«
•
6
5
4
3
2
X4 .
X
X
■
•
X
.
X••
X
•
X
X
•
X
X
DRD/DAC
All from 1 to
___ 29________________
KEY TO AUNEXURE-III
MINISIRIES/DEPARTMENTS - THEIR‘CODE NUA5BERS WITH ABBREVIATIONSCODE NO.
01.DAC
02.DOF
03.MEF
04.DCP
05.MWR
O6.DOP
07.DCS
08.MCC
09.MOR
10.DWCD
11.MHFW
1 2.DOF
13.DRD
14.MUD
15.MOP
16.DPT
17.MID
1 8.CS
19.MOF
20. PC
21 .DOT
22.MOD
23.MBA
24. DOST
25.DOC
26.CWC
27.DID
28.MOT
29.DOW
NAME OF THE MINIS TRY/DEPAR TMg NT
’
Department of Agriculture and Cooperation.
Department of Fertilisers.
Ministry of Environment and Forests.
Department of Chemicals and Petrochemicals.
Ministry of Water Resources.
Department of Power.
Department of Civil Supplies.
Ministry of Commerce.
Ministry of Railways.
Department of Women and Child Development.
Ministry of Health and Family Welfare.
Department of Food.
Department of Rural Development.
Ministry of Urban Development.
Ministry of Petroleum and Natural Gas.
Department of Personnel and Training.
Ministry of Information and Broadcasting.
Cabinet Secretariat.
Ministry of Finance.
Planning Commission.
Department of Telecommunication.
Ministry of Defence.
•Ministry cf Home Affair*.
Department of Surface transport.
Department of Coal.
Central Water Commission.
Department of Industrial Development.
Ministry of Textiles.
Department of Welfare.
____ .21____
<
-1 21
ANNEXURE - 4A
district contingency plan
EARTH QUAKE
ACTION POINTS
I.
Planning and Preparation:
1 .
Identification of earthquake prone areas:
2.
Identification of problems:
l
■
Loss of human life.
Casualties buried' under fallen debris.
Destruction and Damage to Buildings.
Disruption of communication by land, sea and.air.
Disruption of. civic amenities e.g. electricity, water,
transport, medical, telephones, civil supplies etc.
Large scale fires. •
Floods in certain areas.
Landslide in hilly areas.
Disposal of human bodies and animals.
Exposure to disease and danger of epidemics.
Breakdown of law and order.
Breakdown of normal Government machinery in affected
areas due to Government servants themselves being
affected by earthquake.
Loss of morale.
Movement of population.
a)
b)
c)
d)
e)
(
•
.
f)
g)
h)
i)
j)
k)
1)
m)
n)
Identification and Mobilisation of Resources:
Command and Control:
Advance Preparatory Action:
a)
b)
c)
e)
d
h)
i)
J)
Preparation of Plan and skeleton organisation in advance.
Training of Personnel;
Establishment of alternative means of mobile communic at iohs •
Mobilisation of Fire S rvices including auxiliary firemen.
Plans of rescue of casualties trapped under debris.
Provision of hospital, medical and nursing staff.
Medical plans for improvised first aid posts and
emergency hospitals.
Removal of Debris i
Emergency sanitation, alternative supplies of water,
salvage and custody of valuables, procurement,
distribution, accounting of gift, stores, care of animals
etc.
Provision of welfare facilities e.g. care of homeless,
establishment of Camps, information, and guidance on
essential matters, e vacua t ibn/people , alternative
/ of
supply storage distribution of essential commodities
including food, clothing and shelter.
:
•
• • • • fr —•.
. •
.
•
•.
.
vr: ■ ■'
•
'
-
' “t: T-"; L
•' ’
.
"
•
‘
.
r
con td. .
^77 \• -U.r. "• • -
' V.
k
22 :
Disposal- of^the dead and their ‘identifications'
Mobilisation of transport.
Requisitioning of vehicles and issue Of petrol, oil,
lubricant, spare parts and repair facilities.
Protection of properties including objects of art
and things of cultural importance.
Special measure for the protection/repair/restoration
of essential service communications, industrial '
and vital plants.
Publicity.
Prevention of panic and upkeep of morale.
Restoration of communications.
Liasion, particularly with the Armed Forces.
Rehearsal without causing alarm or despondency.
:
k)
1^
m)
n)
o)
p)
q)
r)
s
t)
II.
AFTER AN EARTHQUAKE
■a)
Instant reaction
U)
Establishment of Control
c)
Military Assistance
d)
^orpse Disposal
e)
Medical
t)
Epidemics
5)
Salvage
h)
ployment of Resources
i)
Outs ide Re lie f
j)
Camp-work and Employment
k)
Eire Fighting
•
Inf orma tion
1)
•
23 xK
. "1 ' ANNEXURE 4B
DISTRICT
CONTINGENCY
PLAN
■ - --------------- -----
to
CYCLONE •
action 'points
r
‘ 1• • Action after the first warning
The Collector should ensure i)
ii)
ft
That sufficient stock of foodgrains, kerosene and other
dry food commodities are available for distribution to
the'victims.
. '
That Medical and Veterinary Departments are fully
equipped with required Drugs and Vaccines for taking
preventive steps after cyclone and to arrest the
spread of epidemics.
iii)
That all the Government vehicles are kept in road-worthy
condition for putting them to use in the emergency.
iv)
That a list of generators available with the Cinema
Theatres and other undertakings is maintained by the
Officials of State Electricity Board and advance action
taken immediately to procure them when necessity arises.
v)
That action is taken^for opening of cyclone stores for
providing the following material.
(i)
Hooks of the type available with the Fire Service
Department for cleaning debris
(2)
Rubber tyres and tubes for using as floats in water.
(3)
Tents.
(4)
Kerosene lanterns.
(5)
Large cooking vessels for use in relief
(6)
Identity slips to be issued to be victims in
relief camps.
camps.
•
(7)
Copies of maps,
(8)
Ropes, wires-, charftins, lights with wire
lead wires, torches, etc.
(9)
Spare Road Market Stores, St cl poles, Bomboos,G.C.
Sheets and Slotted Stripes of metal(to be laid on
churod up road surface for better transportation).
(10)
Double handle s h tWs(for cutting fallen trees),
Shovels, Candies, Land Hailers, Hose pipes, first
aid kits, cyclone duty sign Soards, Ropes, Asbestos,
sheets Torch lights, dotty, cans, empty oil drums,
gunny bags and sand bags, polythene bags(for
dropping supplj.es), buckets, V.H,E. sets with
batteries for. v.se
_• .
■
•
etc. ft
fittings,
k
—: 24.: —
(11) .
2.
Fodders, pumps for bailing out water alongwith
hose spades, crow bars, hand gloves, Eucalyptus
oil, napathalene balls, bamboo mats, phenyle
slate line, etc., useful for burying dead bodies
ACTION AFTER RECEIPT OF THE SECOND WARNING
(ACTUAL THREAT)
( i)
Evacua tion
(ii)
Relief to Stranded persons.
(iii)
Stoppage of traffic on National Highways
(iv)
Stock of foodarains
(v)
Declaration of local holiday to the Educational
institutions
3.
POS T-CYCLONE MEASURES
(i)
Convening of the meetings of the Conmittees
(ii)
Rescue Operations.
(iii)
Removal of dead bodies and carcases.
(iv)
Health Measures.
( v)
Restoration of traffic
(vi)
Adequate number of mobile squads shall also be made
available by the Police Department for helping clearing
the fallen trees, etc.
(vii)
Electricity Board should clear the roads of fallen
electric poles and restore power supply as quickly as
possible,
$
■l
II
M■
■
.1
M
— I I
I • »■—
(viii) The Public Relations Department must ensure to build up
photographic record of the damage simultaneously, using
services of* the local Officers or by employing local me
(ix)
Immediately after the .cyclone, the Divisional Revenue
officers should form required number of teams to assess
damage to the houses, crops, loss of human lives,
livestock etc.
• u. <?• .
• ‘HL
I ;W?
1
Annexure-4C
I 25
DISTRICT CONTINGENCY PLAN
FLOOD
ACTION PQINJS;
1 •
(1)
"
Pre-flood arrangements:
Convening a Meeting of the District Level Committee
on Natural Calamities;
;
(ii)
(ill)
Functioning of the Control Rooms;
Closure of'past -breaches in river and canal embank
ments and guarding,o£ weak points;
(iv)
(v)
Rain—recording .and ' submission of rainfall reports'?Communication of g/fuge-readings arfdprfep elation of
maps and charts; ■ '
i
(vi)
Assigning charge of Ri.o.otJ1 Circles ;
(vii)
Dissemination of weather reports and flood bulletins
issuecL&y the meteorological Centres, Central Water
Commission, Flood Forecasting Organisation;
I
J
.
..
pqployment of boats
-
■
•
? •
■ •
-i
*
•■»=<. "
’
■
•
s trategic points;
.
Use of power boats;
(ix)
(x)
;
•
v
‘
’
■
*.
(
-Installation of temporary Tolice Wireless Stations
*■ '.P'arid temporary telephones in f lood-^rone areas J
(xi)
(xii)
Arrang£fnent for- keeping telephone and telegraph
lines in order; .
‘
‘
' • Storage-<rf food in interior, vulnerable strategic and
‘'key arehs;
.
r
1 • •. •
IL .
A
;
(xiii)
Arrangements’of dry fbod stuff and other necessities
of 1^4’n ;
■_
;
(xiv)
Arrangements for keeping the drainage v system’ idesil ted
’’
• and.'properly maintained;•
(\v)
Agricultural measures;
J '
e
(xvi) • . Health measures:
'• / . - ” , ,
\
.
I1
t*
e.;
,
"
■
(xvii)
KVeterinary^ hieasunes ;
(xviii)
Selectiori" of flood shelters^*'
(xixj
Advance 'arrangements for army assistance;
(xx)
Trainihg in flood relief tfotkfc
v . ,
f
■i -
v 1
(xxi)
(xxii)
(xxiii)
. Organisation of relief part.ie^’;
Oilier precautionary measures; and •
*
Alternative drinking-water supply., or? angements.
J
ARRANGEMENT^ DURING AND AFTER FLOODS:•'
—Organising rescue operations.
*•
Organising shelter for the people in distress, in case
the eff—nf the Civr.l authorities are considered
"inadequate, Army aoc’.etanc? should be requisitioned.’
-
Relief measures by non-official and voluntary qxganisations. may be enlisted as far as possible.
~
Organise relief camps.
-
Provision of basic amenities like drinking water. . _r
. sanitation-and 'public health care and arrangements
of cooked food' in the-relief camps.
-
•
•
Making necessary arrangements for air dropping of food
' packets in the marooned villages through helicopters.
‘ Organising enough relief parties to the rescue of-the
marooned people within a reasonable time limit.
Establish alternate communication links to have effec
tive communication with marooned areas.
Organising controlled kitchens to supply foods initially
atieast for 3 days. .
.
•
*
Organising cattle camps, if necessary, and provide
veterinary care, fodder and cattle feed to the affected
animals.
•
Grant of emergency relief to ail the- affected people.
Submission of daily reports and disseminate correct
information through mass media to avoid rumors.
Rehabilitation of homeless.
Commencement of agricultural ac tivi ties-desil tn tion,
resowing.
Repairs and reconstructions of infrastructural facili
ties such as roads, embankments, Resettlement of flood
prone areas.
Health measures.
Relief for economic reconstruction.
;
•/
27
-
AUNEXURE—4D~
DISTR I CT CONTI NGENCY.. PLAN
OT OUGHT
K
•
t
ACTION POINTS:
I.
EARLY WARNING SYSTEM.
*
•
II.'
CONTINGENCY PLANNING FOR AGRICULTURE.
1)
Crop life saving measures.
ii)
The alternative cropping strategy.
iii)
Compensatory Cropping Programme.
•
III.
iv)
Supply of Inputs.
v)
Provision for irrigation.
vi)
Supply of Power.,
•
-
DRINKING WATER:
i)
A detailed contingency plan for supply of
drinking water in rural areas to be formu
lated with technical help from the Central
Ground Water Board(CGWB) and utilising if
need be, the rigs and other capital equip
ment from the CGWB.
•ii)
Made adequate plans'to supply drinking
water in urban areas through bores, tanker
special trains and other’ suitable measures.
*
iii)
Monitor continuously rural and urban
drinking water availability in drought
affected areas.
WATER RESOURCES:
i)
Prepare a water budget for each irrigation
reservoir covering drinking water, kharif
and rabi requirements and evaporation
losses, after working out a trade-off bet
ween kharif and rabi benefits from the
available water.
ii)
Under take ’ repairs of tubewells to make all
tubewells operational and install additional
tubewells taking, care at the same time to
prevent over-exploitation of and damage to ’
ground water regime.
iii)
Regulate supply to water-intensive industries,
if necessary.
iv}
Minimise e.vapora ti-on losses in tanks and small
reservoirspy- using chemical res toratants\
subject’••’td~Health clearance.
‘
•
28
EMPLOYMENT GENERATION:
w
(i)
Adequate scarcity relief works to be taken up to
generate the required employment.
(ii)
The funds available under employment generation
scheme like J.R.Y. , and scarcity relief etc.
should be dovetailed and integrated. •
(iii)
Shelf of projects should be kept ready to be
taken up for employment generation during drought.
(iv)
Drought proofing schemes ~to be identified and to
be given.higher priority.
PUBLIC HEALTH:
•
(i)
•
Disinfect drinking water sources to prevent the
spread of water-borne diseases*
(ii)
draw up plans to -cope with likely epidemics.
(Hi)
constant surveillance of public health measures
including immunisation to be undertaken.
WOMEN AND CHILDREN:
The nutritional requirements of all the children,
expectant mothers and nursing mothers should be
taken care of.
'
•
(i)
--FODDER-:
IV.
• •
•
(i)
Assess fodder requirement in drought .affected
districts and locate areas where shortages are
likely to occur and arrange for supplies from
outside.
(ii)
Monitoring the prices of fodder in selected
places/markets.
(iii)
Arrange
(iv)
State Forest Departments to arrange for the
cutting and bailing of grasses in the forests,
wherever possible to meet the demand from fodder
deficit districts.
(v)
Fodder cultivation 'to be encouraged wherever
feasible.
(vi)
Ensure supply of molasses to cattle feed plants.
(vii)
Obtain from NDDB and other sources premired feed
and urea-moiasses-bricks to the extent necessary.
to procure fodder from surplu
States.
- Media
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