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QUESTION. Do you keep abreast with the local and international news? Do we agree with the remarks of that great 19 th century German pathologist- Rudolph Virhow- that ‘ medicine is a social science, and politics is nothing but medicine on a larger scale’?. A LECTURE BY

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  • Do you keep abreast with the local and international news?
  • Do we agree with the remarks of that great 19th century German pathologist- Rudolph Virhow- that ‘medicine is a social science, and politics is nothing but medicine on a larger scale’?








outline of the lecture
Outline of the Lecture
  • Definition/explanation of concepts
  • Classification of disasters
  • Common disasters in Nigeria
  • Common consequences of disasters
  • Some details on common disasters in Nigeria
  • Disaster management and emergency preparedness: the role of the health services
  • Disaster management in Nigeria
  • Conclusions
  • Further Reading for Doctors, Managers and Policy-makers
1 definition of concepts
  • Disaster: A disaster can be defined as any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant extraordinary response from outside the affected community or area (WHO 1995)
  • Disasters are not confined to a particular part of the world. They can occur anywhere and at any time.
  • Emergencies: An emergency can be defined as a sudden occurrence demanding immediate action that may be due to epidemic, natural, or technological catastrophe or to strife or other man-made causes (WHO 1995).
  • Emergencies arise everyday world-wide.
  • Emergencies and disasters do not affect only health and wellbeing, frequently they cause greater risk of epidemic , and considerable economic harm.
Disasters are the extreme end of the spectrum of harmful events.
  • Some disasters are extreme examples of normal processes, e. g:
  • The normal seasonal hunger turns into famine;
  • The annual flood reaches its 20-year high point,
  • or the normal rises and fall of economic fortune plummets into economic collapse (IFRCRCS , World Disaster Report 1994)
disaster medicine
Disaster Medicine

Disaster medicine is concerned with:

1) Alleviation of the suffering of people affected by disasters

2) Rapid health assessment for emergencies

3) Emergency preparedness, including identification of warning signs, e g for epidemics.

Disaster medicine is multidisciplinary field involving health personnel (doctors, nurses, pharmacists other health workers, other experts: engineers, administrators, security agents, e t c).

the concept of rapid health assessment for emergencies
The Concept of Rapid Health Assessment for Emergencies
  • In disaster management, assessment means collecting information in order to measure damage and identify those basic needs of the affected population that require immediate response (WHO, 1999a)
  • The assessment is always meant to be rapid, as it must be performed in limited time, during or in the immediate aftermath of a disaster
  • The purpose of a rapid assessment is to:
  • confirm the emergency;
  • describe the type, impact and possible evolution of the emergency;
  • measure the present and potential health impact of the disaster
  • assess the adequacy of existing response capacity and immediate additional needs;
  • recommend priority action for immediate response
the concept of emergency preparedness
The Concept of Emergency Preparedness
  • Recall that disasters cause great harm to people, communities and countries, affecting current population and existing infrastructure and threatening the future of sustainable development
  • Therefore, neither communities nor governments can afford to wait for emergencies and disasters to occur before responding to them.
  • The suffering caused by injuries and deaths, social and economic disruption, and the destruction of environment can be reduced through various measures designed to reduce vulnerability
  • What is emergency preparedness? Emergency preparedness is a programme of long term development activities, whose goals are to strengthen the overall capacity and capability of a country to manage efficiently all types of emergency and bring about an orderly transition from relief through recovery and back to sustained development (WHO 1999b)
a examples of sudden impact natural disasters
A) Examples of Sudden-impact Natural Disasters
  • Cyclones
  • Hurricanes
  • Gales
  • Tornadoes
  • Tidal Waves
  • Storm Surges
  • Tsunamis
  • Flash Floods*
  • Fires (large-scale devastating forest fires, e.g. in Australia, USA)
  • Earthquakes
  • Landslides
  • Avalanches
  • Volcanic Eruptions
b examples of epidemics of infectious origin
B) Examples of Epidemics ofInfectious Origin
  • Epidemic Meningococcal Meningitis*
  • Cholera*
  • Yellow Fever Epidemic*
  • Lassa Fever*
  • Ebola
  • Dengue
  • Other Hemorrhagic Fevers
  • Influenza Epidemic
  • SARS
  • Avian Influenza Epidemic, etc
c examples of other natural disasters
C) Examples of Other Natural Disasters
  • Drought*
  • Locust Invasion*
  • Famine*
  • Both drought & locust invasion can lead to loss of crops & famine
examples of man made disasters
Examples of Man-made Disasters
  • Wars
  • Strife
  • Generalized violence
  • Chemical emergencies
  • Air disasters
  • Terrorist bombings
  • Fires
  • Nuclear Disasters
3 common disasters in nigeria


Sudden-impact natural disasters

  • Floods*

Epidemics of Infectious Origin

  • Epidemic Meningococcal Meningitis*
  • Cholera
  • Yellow Fever Epidemic
  • Lassa Fever

Other Natural Disasters

  • Drought*
  • Locust Invasion
  • Famine
  • Both drought & locust invasion can lead to loss of crops & famine
  • * Some details are given on these in the discourse
common disasters in nigeria cont d
Common Disasters in Nigeria- Cont’d


  • Strife*
  • Generalized violence*
  • Chemical emergencies*
  • Air disasters*
  • Fires*
  • Terrorist bombings*

* Some details are given on these in the discourse

4 common consequences of disasters



1- Sudden population displacement

2- Nutritional emergencies (famine)

3- Outbreak of epidemics due to overcrowding, poor sanitation, inadequate safe supply of water.

common consequences of sudden impact natural disasters
Common Consequences of Sudden-impact Natural Disasters
  • Kill a large number of people (mortality increases)
  • Injure a large number of people (morbidity increases)
  • Cause extensive
  • social damage
  • economic damage
  • Often create an immediate obstacle to response by disrupting vital services, e.g.

- water supply

- health services

- security services

- communication

- transportation

common consequences of man made disasters
Common Consequences of Man-made Disasters
  • Wars, strife and generalized violence kill a large number of people (mortality increases). They also cause injury to a large number of people –causing mass surgical casualties
  • Air disasters and terrorist bombings usually deliver few intensive care patients, since only a small percentage of these patients have delayed deaths. This is a reflection of the mechanism of injury. The majority of patients from these situations will have either injuries producing immediate deaths, obviously mortal injuries, or minor to mild injuries (See Frykberg & Tepas 1988, 1989)
  • Chemical disasters such as toxic fumes, smoke inhalations from high-rise structure fires and nuclear radiation exposures are medical mass-casualty incidents which are less frequent but more likely to deliver many patients to the intensive care unit (Ferguson el al 1992)
  • Recall the recent incidence of acute, severe, large-scale lead poisoning in children in Zamfara State, north-western Nigeria, in which thousands of children were affected, with hundreds of deaths (MSF, 2012)
5 some details on selected common disasters in nigeria

Brief discourse on:

  • Natural disasters
  • Floods
  • Epidemic meningococcal meningitis
  • Drought and famine
  • Man-made disasters:
  • Strife and generalized violence
  • Terrorist bombings and air disasters
  • Fires and chemical disasters
  • Flooding is the most common of all environmental hazards. It is estimated that it claims over 20,000 lives per year and adversely affects about 75 million people world-wide (Etuonovbe, 2011).
  • Other estimates indicated that from 1993 to 2002 flood disasters affected about 140 million people per year, which is more than all other natural or technological disasters put together (IFRCRCS 2003)
  • In Nigeria, flooding in various parts of the country have forced millions of people from their homes, destroyed business, polluted water resources and increased the risk of disease
  • Mortality and morbidity are due to drowning, near-drowning, collapse of buildings and water pollution.
floods cont d

Causes of Flooding in Nigeria

  • Natural causes
  • Heavy/torrential rain
  • Ocean storms and tidal waves
  • Types of Flooding in Nigeria
  • Man-made
  • Dam burst
  • Dam spills


flooding River flooding Flash floods Urban fld Dam b&s

Medical Consequences of Flood Disasters
  • Mortality is high only in the case of sudden flooding- flash floods, the collapse of dams, or tidal waves
  • Morbidity: fractures, injuries, bruises; and in cold weather accidental hypothermia may occur (WHO, 1989)

Meningitis belt lies within 300mm to 1,100mm of annual rainfall i.e.

  • corresponds to Sudan and Sahel Savannah of Africa ( northern part of sub-Saharan Africa).
  • - In this belt short severe epidemics occur every 5-10 year
  • - Mortality: 3-20% - with mortality tending to fall as the epidemic progresses.
  • Last major epidemic reported by WHO – 1996; 300,000 cases. Most affected countries: Nigeria, Niger, B/Faso and Mali. Recent epidemic: Feb. – May 2008 and March-May, 2009
  • - In Nigeria epidemics have occurred rarely outside the meningitis belt.
  • - Remember that:
  • Meningococcal meningitis in its epidemic form occurs worldwide.
  • In this case the predominant serogroup depends on geographical
  • location.
  • Serogroup A is the predominant cause of the disease in Africa during both
  • endemic (sporadic cases) and epidemic periods.
  • Serogroup B – major cause of disease and small outbreaks (in winter and
  • spring) in Europe.
  • - Serogroup C – can also cause disease and epidemics – especially in Africa.
  • The major group causing epidemics i.e. A, B and C can be sub-typed into
  • clones for epidemiological study.
  • Clonal analysis is based on eletrophoretic variation of the bacterial
  • cytoplasmic isoenzymes and major outer membrane proteins.



The area enclosed within the bold lines approximately

corresponds to the sudan savannah and sahel regions

where meningococcal meningitis epidemics occur at

fairly regular 10-year intervals. Map is modified from

Lapeysonnie (1963) and Achtman (1991)


Serogroup A: can be divided into several groups:

AI, AII, AIII, AIV, AV, AVI. Each subgroup has several clones.

numbered 1 – 4 e.g. serogroup AIII has the following clones: AIII-1, AIII-2, AIII-3 and AIII-4.

This sub-grouping is important in studying epidemics:

Note: each wave of a given epidemic of group A disease is caused by a particular clone.

By using clonal analysis the origins of an epidemic (or pandemic) of group A meningococcal infection can be traced and the spread of this particular epidemic from country to country can be followed.

Age Distribution of Meningococcal Disease

Non-epidemic periods : Mostly 3 months – 5 yeas (>50% cases)


(Africa): 5 – 14 years

(Europe and N. America): Young children are mostly affected


People prone to infection during epidemics:

    • Children living in crowded conditions, e.g.
  • - pupils in traditional Qur’anic schools;
    • Young people in closed communities;
  • - boarding schools
  • - military recruits
  • . Any crowded living conditions can increase likelihood of infection
  • during epidemics.
  • Pointers to epidemic outbreaks. The immediate pointer to an
  • epidemic outbreak is the attack rate.
  • When the attack rate exceeds 15 cases per 100,000 population for 2 weeks in a row, it is likely that an epidemic of meningococcal infection is on.
  • In one epidemic of meningococcal disease in Zaria, Northern Nigeria, the overall attack rate reached 360 per 100,000. This is extremely high.
  • Note: In the meningitis belt, there is seasonal variation in incidence of BM. Outside the belt there is no variation in incidence.
  • - Humans are the reservoir of meningococci.
  • - Not every person exposed to pathogenic meningococci develops clinical
  • symptoms.
  • - Healthy individuals can carry meningococci in the nasopharynx.

Mode of spread of meningococci (whatever the serogroup) is fromperson to person by direct contact with respiratory droplets of infected person.

  • All humans are susceptible to meningococcal disease, but disease risk is higher in persons with:
  • - Terminal complement deficiency (C5 – C9), splenectomy, patients with sickle cell disease
  • Incubation period
  • 1-10 days with a mean of 4 days.
  • - The organism initially colonizes the nasopharynx.
  • Under special conditions – e.g. under-nutrition, overcrowding and reduced immunity to a particular clone (reduced herd immunity) there is spread via the blood stream to other parts of the body and the meninges.

Prevention and control:

  • Mass vaccination during epidemics of meningococcal disease. Bivalent A&C vaccines used during epidemics in the meningitis belt
  • Chemoprophylaxis of contacts for limited outbreaks among closed populations (household, boarding schools, day-care centres)
  • Chemoprophylaxis is however not warranted as a control measure against spread of meningococcal meningitis in severe epidemics. For such epidemics mass immunization is more appropriate.

Treatment under difficult circumstances

  • Under difficult circumstances, when health workers are overwhelmed by multitude of patients in an epidemic of meningococcal meningitis, long-acting chloramphenicol or other forms of short-course antibiotic regime can be used in the treatment of the disease
Medical Consequences of Droughts
  • If famine occurs mortality is high in such areas.
  • Morbidity is increased due to increase in PEM- marasmus, kwashiorkor
  • Incidence of vitamin A deficiency increases in children causing xerophthalmia, blindness and reduced immunity in children.
  • In the conditions of famine, measles, respiratory infections and diarrhoea can bring massive increase in morbidity and mortality
  • Population displacement with overcrowding and poor hygiene may facilitate the spread of endemic communicable diseases- e .g., tuberculosis, parasitic diseases and malaria (WHO, 1989)
strife and generalized violence the nigerian situation review of some historical aspects
Strife and Generalized Violence: The Nigerian Situation: Review of Some Historical Aspects
  • I have prepared a catalogue of strife and generalized violence from 15th century when the area, to be known later as Nigeria, was the target for British and Portuguese economic exploitation including extensive slaving, to the period of gradual British control (1861-1914), to the 1965 western Nigerian post-election violence, the Nigerian civil war, up to the current security situations in the Niger Delta, Plateaux State, and the terrorist bombings and armed attacks in northern Nigeria (see Copley RG 2006, and various news reports from 2007-2012).
  • I have summarized the effects of such man-made disasters in subsequent discourse, with special reference to the current Nigerian situation.
strife and generalized violence the nigerian situation age of terrorist bombings
Strife and Generalized Violence- The Nigerian Situation: Age of Terrorist Bombings
  • In the last 2 years northern Nigeria has been adversely affected by regular terrorist bombings and armed attacks on :
  • churches
  • mosques
  • public squares
  • public buildings
  • parking spaces
  • markets
  • banks
  • residential areas
  • police stations
  • police posts
  • universities
  • primary schools
  • prison yards
  • bridges
  • several villages and communities
terrorist bombings and complex emergencies
Terrorist bombings and Complex Emergencies
  • Every disaster, whether natural or man-made, creates problems for maintaining law and order and performing day-to-day police functions
  • Law and order must be maintained even during disasters and emergencies. This may prove difficult since police may be heavily committed to emergency operations
  • Police organizations will need to develop operational plans that ensure sufficient resources for normal policing and security (WHO 1999b)
  • However, the recent terrorist bombings in northern Nigeria are creating complex emergencies, since the security agents are also the target of attacks.
  • Complex emergencies are situations where the cause of the emergency as well as assistance to the afflicted are bound by intense level of political considerations (WHO, 1999a)
terrorist bombings and complex emergencies1
Terrorist bombings and Complex Emergencies
  • Complex emergencies are characterized by varying degrees of instability and even collapse of national authority
  • This leads to loss of administrative control and to the inability to provide vital services and protection to the civilian population
  • One main feature of complex emergencies is the actual or potential generalized violence against human beings, the environment, infrastructure and property
  • Violence has a direct impact in term of deaths, physical and psychological trauma and disabilities
  • In conflicts characterized by rapidly shifting zones of combat, as is today happening in northern Nigeria, where government is confronted with low-level insurgency by faceless organizations supported by fleeing Chadian rebels and other foreigners, civilians often find themselves under cross fire.
  • In many instances in complex emergencies, civilians become primary targets of ethnic and religious cleansing, murder, sexual abuse, torture and mutilation
terrorist bombings armed attacks and complex emergencies possible effects on public health
Terrorist bombings, Armed Attacks and Complex Emergencies: Possible Effects on Public Health

The other effects of conflict on public health are mediated by a variety of circumstances that include:

  • Population displacement with concentration in camps, public buildings or other settlements. This causes an increase in the risk of acute respiratory infection, diarrhoea, dysentery, measles and other epidemics. The dependence on food rations entails risk of malnutrition.
  • The loss of opportunities and instruments of production, food stocks, and purchasing power due to destruction or interference of commercial network can result in food shortages and population migration.
  • Armed attacks and bombings, in addition to targeting civilian population, can damage infrastructures such as roads, water plants, communications and even health facilities.
  • The general economic crisis due to decreased production, loss of capital and increased military expenditure can force cuts in the budgets for social sector including health
  • Insecurity and military operations may restrict access to affected areas and limit the delivery of health services and recovery operations
fire disasters
Fire Disasters
  • In Nigeria fire incidents affecting individual homes, markets, government offices, petrol stations and private business enterprises are too numerous to catalogue
  • Data obtained from the Nigeria Fire Service for the year 2010 indicated that there were 7129 incidents of fire in the country that destroyed 990 lives and property worth over N53 billion (See Ojo 2011)
  • Fires, of disaster magnitude, arising from deliberate or accidental rupture of petroleum pipelines, are also not uncommon; so are fires affecting large markets from Lagos to Sokoto
  • In recent years fires from air disasters and terrorist bombings have compounded the problem
  • WHO (1999b) recognizes search and rescue as one of the six major sectors in disaster management and emergency preparedness. The other five sectors include: communication, health and medical, social welfare, police and security, and transport and lifelines.
  • With regards to search and rescue, it is suggested that the Head of this sector should be the Chief of fire department (WHO, 1999b)
fire disasters1
Fire Disasters
  • It is also recommended that the role of the Fire Service (or Fire Department) in disaster situations is fire fighting, rescue work, clearing rubble, protection of individuals and property (WHO, 1999b)
  • The fire department cooperates with other rescue services, public or private companies and utilities (water and electricity) in achieving these goals

Fire Service in Nigeria: Brief Historical Review and the Current Status

  • Recall that the Nigeria Fire Service (NFS) is over one hundred years old. It started operations in1906 under the Lagos Police Fire Department. Subsequently, it became the Federal Fire Service (FFS) under a Controller-General. Furthermore, currently each state of the federation has also State Fire Service.
  • It is asserted that of all the disaster management agencies, the Nigeria Fire Service is the least equipped and staffed to play its vital role (Ojo, 2011)
  • Information from the Controller- General of FFS in 2010 indicated that the country needed 5,000 fire service stations to effectively fight fire outbreaks. However, Nigeria has only 269 of such stations nationwide.
fire disasters2
Fire Disasters

Fire Service in Nigeria: Brief Historical Review and the Current Status (Cont’d)

  • Furthermore, in the vast majority of the fire stations functional trucks for dispensing water are not available. Similarly, modern equipment for fire fighting is rarely available. There is paucity of water, air breathing apparatus, fire-resistant garments, fire blankets, megaphones, first aid kits and helicopters (Ojo, 2011)
  • Other challenges faced by the NFS both at federal and state levels include: absence of water hydrants at street corners in large cities, lack of fire escape for high-rise structures, non-enforcement of fire-prevention laws at petrol stations, lack of recruitment of new staff and poor funding. Recall that the last time FFS recruited was in 2001 (11 years ago!)
  • Fire disasters are one of the commonest man-made emergencies in Nigeria; therefore, the need for improvement in our fire-fighting capability is urgent.
fire disasters3
Fire Disasters

Fire Service in Nigeria: Brief Historical Review and the Current Status (Cont’d)

  • Let me conclude this section by referring you to the editorial commentary in The Nation newspaper of yesterday, Friday 11, 2013 in which the Editor of that newspaper, in his article with the title Fighting Fires, summarized the current status of our country’s overall capacity in fire-fighting. The conclusions of the editor were based on the most recent fire disasters in the country: the inferno at Jankara Market in Lagos (December 26th, 2012) and the fire out break at Ikoku Market in Port Harcourt (early hours of New Year’s day – 1/1/ 2013) in which many shops were destroyed.
  • In both disasters there were poor preventive measures, inadequate resources for fire-fighting and poorly implemented investigative procedures. In the case of Ikoku Market fire outbreak, the market did not have fire extinguishers on the premises; there was no clearly outlined fire drill which could have enabled an immediate and organised response to the fire; the State’s Fire Service declined to show up, claiming that it did not have water; the fire-fighting unit of a multinational oil company, which tried to help, could not get to the market due to lack of access roads.
fire disasters4
Fire Disasters

Fire Service in Nigeria: Brief Historical Review and the Current Status (Cont’d)

  • We need to increase public awareness of fire-preventing measures, commence the culture of fire drills. Such drills are an almost-unknown occurrence in the country, in spite of their obvious importance. The habit of providing just one entry and exit point in buildings and on housing estates must be discontinued.
  • There must be increased investment in the training of fire-fighting personnel and the provision of functional requisite equipment. The welfare of fire-fighters must be catered for. They are as important as other cadre of personnel engaged in provision of essential services.
  • As the country begins a new year, we hope that sustained efforts will be made to limit the agony and sorrow caused by fire disasters to the barest minimum (Editorial, The Nation, January 11, 2013)
chemical emergencies disasters
Chemical Emergencies/Disasters

Chemical disaster in the Niger Delta

  • The ecological disaster caused by oil exploration in the Niger Delta is a well known phenomenon. It has caused destruction of the fauna and flora in this region- causing loss of means of livelihood of hundreds of communities, and has been the main reason for agitation and generalized violence in this region for many years

Lead poisoning disaster in Zamfara State

  • In March 2010, Doctors Without Borders/ Medicins San Frontieres (MSF) was alerted to a high number of childhood fatalities in Zamfara State of Nigeria
  • An estimated 400 children died; laboratory testing later confirmed high levels of lead in the blood of surviving children
  • MSF has for the moment controlled mortality by chelation therapy. However, long term treatment and follow-up will be needed in patients with lead poisoning
chemical emergencies
Chemical Emergencies

Lead poisoning disaster in Zamfara State

  • The root cause of the poisoning disaster is unsafe mining and ore processing in search for gold. Zamfara state is endowed with huge deposits of gold, heavily mixed with lead
  • Miners , (including thousands of children) engaged in archaic methods of mining in Zamfara State, are therefore exposed to huge amounts of toxic lead; and children are more vulnerable to lead toxicity than adults

Magnitude of the disaster: As of June 2010 mortality dropped from 43% (prior to chelation therapy) to 2% in areas where MSF provided therapy

  • More than 2,500 children have been enrolled in treatment programme; 2000 children were still on treatment
  • 500 children with blood levels of 45ug/dl are on follow up, but not active treatment. (Recall that the Centers for Disease Control- CDC, Atlanta, Georgia, USA) recommends that for young children blood lead levels from 10ug are levels for concern (CDC 1991)
  • About 300 children have been discharged, but need long-term follow-up, and 60 children died (MSF, 2012)
  • It is obvious that Government should ensure safer mining technology in Zamfara State
6 disaster management and emergency preparedness the role of the health services

In disaster management and emergency preparedness 3 periods must be recognized (WHO,1989; Ferguson al, 1992):

  • Pre-disaster period
  • The period of the disaster:

a) pre-hospital, on-the-scene, period

b) hospital care period

3) The aftermath (the period following the disaster)

The following tables, based on extensive review of the literature, summarize the actions to be taken during each period, and the organizations, experts, and professionals, particularly doctors and other health workers to be assigned those responsibilities.

6 disaster management and emergency preparedness

Stages of Disaster Management and the Role of the Health Services

* See components of a disaster plan in subsequent slides

6 disaster management and emergency preparedness1

Disaster Plan/ Emergency Planning/Disaster Preparedness Plan

  • An emergency plan is an agreed act of arrangements for responding to and recovering from disasters and emergencies. The plan describes responsibilities, management structures, strategies and resources (WHO, 1999b)
  • There should be a national emergency plan, local community emergency plan and hospital emergency plan, for protecting life, property and environment
  • The health sector plays a key role in emergency planning, regardless of the system adopted by a country (WHO, 1999b)
  • Health and medical planning must include the broad health sector, public health, mental health, nutrition, hospital emergencies, the integration of rescue and medical services, triage and first aid (WHO,1999b)
  • At hospital level, there is evidence from studies from military and civilian disasters that preparations and rehearsal for mass-casualty situations, is the single most beneficial factor in patient salvage during an actual disaster (Ferguson et al, 1992)
  • At the hospital level disaster preparedness plan should address the following general areas:
  • Consideration of the nature of likely disaster (e.g. fire, floods, terrorist bombings and armed attacks, epidemics, chemical emergencies)
6 disaster management and emergency preparedness2

Disaster Plan/ Emergency Planning/Disaster Preparedness Plan (at hospital level- cont’d)

  • Preparation and rehearsals for mass casualty situations (part of hospital emergency preparedness)
  • Create a disaster planning committee with intensivist’s input
  • Establishment of central control centre or central coordinating committee (CCC)
  • Resource utilization: people, supplies, facilities

- what will be required?

- what is available?

- what can be readily obtained

- how will resources be allocated?

  • Transportation of staff to hospital, patients within hospital, supplies within hospital, patients to other hospitals
  • Triage: arriving patients from disaster scene; existing patients
  • Practice: drills

Note disaster management plans at hospital level should address these broad areas. Details will depend on the nature of disaster and feedback from drills (Ferguson et al, 1992)

6 disaster management and emergency preparedness3

Disaster Plan/ Emergency Planning/Disaster Preparedness Plan

  • The ability to cope, manage and survive a disaster is improved by foresight and planning
  • A pre-arranged disaster plan and regularly scheduled drills are the keys to successfully dealing with disasters
  • Since the very nature of many disasters there is little warning or no warning of the impending mass casualties, details of the demand to be placed on intensive care service will not be known and cannot be anticipated
  • There are however enough predictable challenges that are likely to be involved in mass casualty event that plans and drills have shown to facilitate coping with disaster:

Air disasters

Terrorist bombings

Few intensive care unit (ICU) patients

Toxic fumes, fires+ smoke inhalation, chemical disaster many ICU patients

6 disaster management and emergency preparedness4

Stages of Disaster Management and the Role of the Local Health Personnel

6 disaster management and emergency preparedness5

Suggested organizational plan for delegation of responsibilities in managing disasters at the hospital level (Modified from Ferguson et al, 1992). Double-headed arrows indicate exchange of information; CCC= Central coordinating committee, central control centre




















*See comments next slides


6 disaster management and emergency preparedness6
  • In Nigeria emergency medical service is still not established
  • Doctors and other health workers are not involved in the pre-hospital stage of disaster management




















*See comments next slides


6 disaster management and emergency preparedness7

Stages of Disaster Management and the Role of the Local Health Personnel

6 disaster management and emergency preparedness8

Stages of Disaster Management and the Role of the Local Health Personnel

* See details on these given in subsequent slides

6 disaster management and emergency preparedness9

Stages of Disaster Management and the Role of the Local Health Personnel

6 disaster management and emergency preparedness10

Stages of Disaster Management and the Role of the Local Health Personnel

Disaster Management: The Aftermath

Immediately after the disaster (the aftermath) the actions that must be taken and the responsible persons and organizations that should take the necessary actions have been summarized in previous slides in tabular form. Some details on problems and care of displaced persons, including provision of temporary shelter for such people are given in the next slides.

displaced persons cont d1
Displaced Persons- Cont’d
  • Sudden population displacement is usually caused by

sudden-impact natural disasters e.g. flash floods (see list in classification) or man-made disasters: wars, force, violence, threat of force, or other pressures. The displaced persons may move in a large group over a short period.

  • More gradual displacement is usually the result of drought or famine. The displaced persons may move in small groups over months or years.

Displaced persons: Definitions

  • Refugees: Displaced persons who cross international borders (WHO,1999a).The country to which they flee is referred to as Host Country.
  • Internally Displaced: Displaced persons who do not cross international border and remain within their country of origin.
problems of displaced persons
Problems of Displaced Persons
  • Large concentrations of displaced persons may be found in poor peripheral or underserved sections of large cities.
  • The sudden arrival of large numbers-sometimes hundreds of thousands- can create a health emergency

Provision of Temporary Shelter and Sanitation

  • When disaster has rendered houses uninhabitable and there has been no evacuation of the area, temporary shelter must be arranged for those affected.
  • Initial behaviour of the people: These people prefer to remain on the spot in or near their property. Often the affected population settles all over the place: waste ground, gardens, parks, town square, parking areas, sports ground, etc
  • They may use any material that comes to hand for setting up temporary shelters planks, plastics, tents, cars, containers, boats, railway wagons, buildings under construction, schools, public buildings

Deterioration of Sanitary Situation and the Need for Organized Temporary Shelter.

  • The sanitary situation under this chaotic system of settlement rapidly deteriorates and it becomes very difficult to assess requirements.
problems of displaced persons cont d
Problems of Displaced Persons- Cont’d

Deterioration of Sanitary Situation and the Need for Organized Temporary Shelter (Cont’d)

  • Therefore, it is suggested that communities exposed to the risk of disaster and those that propose to give shelter to displaced persons should select sites for temporary shelter-even before disaster strikes. Necessary preparatory work should be carried out.

Selection of Temporary Shelter: Desirable Characteristics

  • The sites chosen for erecting temporary shelters should be:
  • Flood proof, above high water level
  • Preferably on gentle slope to facilitate rain water and waste water drainage
  • Not too close to the water table; otherwise the ground could become marshy in the rainy season
  • Protected against landslide and subsidence
  • Easily accessible, not far from the centre of population
  • At higher level than waste tips
  • Downstream from sources of drinking water
problems of displaced persons cont d1
Problems of Displaced Persons- Cont’d

Other Important Issues on Temporary Dwellings

  • In laying out camps for temporary dwellings, for refugees or internally displaced persons, geometric designs with shelters arranged in anonymous rows should be avoided. Groupings of families and choice of neighborhoods must be encouraged- while keeping sanitary situation under control.
  • It should be decided whether settlement is expected to be used for long periods, or for a very short period
  • If it is for long period, provision must be made for housing, local administration, health centre/hospital, school, other community services and other community activities

Necessities to be Provided at the Site of Temporary Shelter

On the site of temporary shelter it is necessary to arrange:

  • Water supply points; 2) Latrines; 3) Waste tips

1) Water Supply

  • During the first few days it is sometimes necessary to use tanker trucks for transporting water.
  • Later, as soon as possible, water supply points should be established by sinking bore holes, digging wells or laying pipes.
problems of displaced persons cont d2
Problems of Displaced Persons- Cont’d

Necessities to be Provided at the Site of Temporary Shelter

Water supply (cont’d)

  • If there is shortage of water people will congregate near supply points. Therefore it is recommended (WHO 1989) that there should be ONE water supply point for every 200-250 persons, maximally.

2) Latrines

  • Ideally one per family; minimum one seat per 20 people, 6-50m from housing

3) Refuse disposal

  • One communal pit- 2m x 5m x 2m per 500 people
  • Rubbish tips should be arranged for disposing solid waste. This solid waste will be burnt and covered with earth to keep flies and rodents away.
problems of displaced persons cont d3
Problems of Displaced Persons- Cont’d
  • It is important that doctors in Nigeria should be conversant with the vital needs of displaced persons in a temporary shelter.
  • There are some important reference values for rapid heath assessment in disaster situations recommended for developing countries that we should be familiar with, especially if we are called upon to assist in alleviating the suffering of displaced persons housed in temporary shelters in the aftermath of a disaster.
  • The reference values summarized below are based on the recommendations of WHO (1999a):

A) Vital Needs:

  • Water:
  • Quantity: Indicated by no. of liters per person per day = 20L/person/day;
  • b) Quality: Indicated by no. of users per water point and distance from housing= 200 people/water point, not more than 100metres from housing;
  • c) Safety: Indicated by freedom from heavy bacterial contamination. The drinking water can be disinfected by chlorination and allowed to stand for 30 minutes before using.
problems of displaced persons cont d4
Problems of Displaced Persons- Cont’d

A) Vital Needs:

2) Food

a) Cereals: These should supply energy content of 350 kcal/100g.The required ration is 10.5 kg/person/month

b) Pulses: These should contain 335 kcal/100g.The required ration is 1.8 kg/person/month

c) Oil: Energy content of 860/100g.The average requirement is1.2 kg/person/month

d) Sugar: Energy content of 400kcal/100g.The average requirement is 1.2 kg/person/month

NOTE: Energy value of recommended ration for one person per day = 2100kcal; and the total weight of uncooked food (cereals, pulses, oil and sugar) required by one person per month = 14.7kg

3) Sanitation: Latrines and waste disposal have been mentioned before

4) Space for Accommodation

a) Individual requirement for shelter only; average need = 4M²/person

b) Collective requirement, including shelter, sanitation, services, community activities, warehousing and access; average need = 30M²/person

problems of displaced persons cont d5
Problems of Displaced Persons- Cont’d

A) Vital Needs:

5)Household Fuel

  • a) Firewood? Average need = 15kg/household/day or 5kg/stove/day-with an economic stove
  • b) Other sources of fuel like kerosene? Remember environmental sustainability and MDGs

B) Health Needs and Care of Displaced Persons in Temporary Shelters

The local health personnel (LHP) should establish a system to monitor:

  • communicable diseases: Endemic diseases, including those of the area of origin of the displaced persons;
  • the nutritional and growth status of the children.

The LHP should also set up a provisional health post near the displaced persons to provide them with

  • Routine care: medical, surgical, psychiatric, and ante-natal care; b) Vaccination; c) Health education

The LHP will be assisted by volunteers from the community and by the displaced persons organization (DPO).

problems of displaced persons cont d6
Problems of Displaced Persons- Cont’d

B) Health Needs and Care of Displaced Persons in Temporary Shelters

1) It is important to remember that in temporary shelter situations, prevalent health hazards and expected attack rates in such emergency situations can be as high as indicated below (WHO, 1999a):

2) Essential PHC activities must include: a) Conducting under-5 clinic and growth monitoring for all children in the camp. Target: all children 0-59 months; optimal coverage: 100% of <5s/month.

b) Antenatal clinic

7 disaster management in nigeria
  • What have the Nigerian Governments done over the years with regards to policy issues on emergency preparedness and disaster management?
  • With regards to policy:
  • What should the Nigerian Governments do to improve disaster management?
  • What should NEMA do to improve disaster management?
  • What should our hospitals do to improve disaster management?
  • What should the Nigerian medical schools do to improve disaster management?
7 disaster management in nigeria policy issues
  • What have the Nigerian Governments done over the years with regards to policy on emergency preparedness and disaster management?

*Remember: NEMA replaced NERA (National Emergency Relief Agency

which was created by decree 48 of 1976 in response to the famine of 1973)

7 disaster management in nigeria1
  • What have the Nigerian Governments done over the years with regards to policy on emergency preparedness and disaster management?
7 disaster management in nigeria2
  • What have the Nigerian Governments done over the years with regards to policy on emergency preparedness and disaster management?
7 disaster management in nigeria3
  • In the aftermath of a disaster, involvement of health workers even in distribution of relief materials is the rule, rather than exception.
  • Recall that in July, 1968, the Federal Military Government of Nigeria asked the International Committee of the Red Cross (ICRC) to assist the Nigerian Red Cross (NRC) in distributing relief food and medical care to internally displaced victims of the Nigerian civil war. Volunteer medical and relief teams of ICRC/NRC Joint Relief Action participated in the exercise.
  • From early reports of relief workers, the nutritional status of the population in the affected area was very poor. Famine was present in in epidemic proportions; kwashiorkor and marasmus were common.
  • The early efforts of the Joint Relief Action were spent distributing relief food as rapidly and to as many people as possible. Temporary in-patient hospitals were established to treat all cases of frank kwashiorkor and marasmus (See Davis LE, 1971)
  • It is not clear, now, why NEMA and SEMAs do not involve doctors and other health workers in their field work of distributing relief materials to victims of disaster.
7 disaster management in nigeria4
  • What have the Nigerian Governments done over the years with regards to policy on emergency preparedness and disaster management?
7 disaster management in nigeria5


  • We need disaster management plan in every hospital in Nigeria, with regular drills as is done elsewhere (Ferguson et al 1992)
  • The Disaster Management Agencies established by Government (Fire Service, Road Safety, NEMA) should be properly equipped and reorganized to handle current and emerging disasters in Nigeria.
  • We must squeeze into the medical curriculum some of the important aspects of disaster medicine- with special reference to the organizational issues.
8 conclusion
  • Nigerians are good in criticizing their leadership. That may be an asset. But:
  • Let us be positive about Nigeria
  • Let us think and dream positively about Nigeria
  • Let us act positively for Nigeria
  • From the chronology of strife and generalized violence I have highlighted, it is obvious that Nigerians are very resilient people, and I believe we can and must overcome our security challenges and avert escalation of violence that can lead to complex emergencies and disasters.
  • The present gaps in our emergency preparedness should be addressed
  • Appropriate disaster preparedness and management is crucial for a developing country like Nigeria, whose poverty profile and human poverty indices are among the worst in the world (See Ahmed H, 2007b)
  • With our resilience, we can forge ahead for greater development, peace and progress of our country- towards that dream of ‘one nation bound in freedom, peace and unity’.
9 further reading for doctors health managers and policy makers

WHO Documents:

  • World Health Organization. Coping with natural disasters: the role of local health personnel and the community, WHO, Geneva, 1989: 1-95
  • World Health Organization. Rapid health assessment protocols for emergencies, WHO, Geneva, 1999a: 1-97
  • World Health Organization. Community emergency preparedness: a manual for managers and policy makers WHO, Geneva, 1999b: 1-141
  • WHO: Control of epidemic meningococcal disease; WHO practical guidelines, 2nd ed, available @ http//www. who. Int/emc

Other References

  • Agabi C. Nigeria: Lagos floods- What Federal, State Govts Have Overlooked. Daily Trust, 5th July, 2012
  • Ahmed H. Inflammatory Diseases of the central nervous system. Chapter 65, In: Azubuike JC & Nkanginieme KEO (eds) Paediatrics & Child Health in a tropical region. African Educational Services, Owerri, Nigeria, 2nd ed, 2007a :525-570
other references
Other References
  • Ahmed H. Effects of poverty on child health and paediatric practice in Nigeria: an overview. Ann Afr Med, 2007b; 6 (4): 142-156
  • Centers for Disease Control (CDC). Preventing lead poisoning in young children: a statement by Centers for Disease Control, Atlanta, GA, October, 1991
  • Copley RG (Editor). Nigeria: In: Defense & Foreign Affairs Handbook, 16th ed, International Strategic Studies Association, USA (Publishers), 2006: 1421-1437
  • Davis LE. Epidemiology of famine in the Nigerian crisis: rapid evaluation of malnutrition by height and arm circumference in large populations. The American Journal of Clinical Nutrition, 1971; 24 (March): 358-364
  • Etuonovbe AK. The devastating effect of flooding in Nigeria. FIG Working Week 2011, Bridging the gap between cultures, Marrakech, 18-22 May 2011, pp 1-15
  • Ferguson KI, Walleck C, Jastremski M. Disaster management. In: Hall JB, Schimidt GA, Wood LDH. Principles of critical care Vol 1. Mc Graw-Hill, 1992, pp 580-584
other references1
Other References
  • Frykberg, ER, Tepas II. Terrorist bombings: lessons learnt from Belfast to Beirut. Ann Surg, 1988; Nov: 208-569
  • Frykberg, ER, Tepas II. The 1983 Beirut airport terrorist bombing: injury pattern and implication for disaster management. Ann Surg 1989; March: 55-134
  • IFRCRCS. World Disaster Report ,1994
  • IFRCRCS: World Disaster Report, 2003
  • Medicins San Frontieres (Doctors Without Borders): Briefing documents: Lead poisoning crisis in Zamfara State, Northern Nigeria, 2012
  • The Nation (newspaper): Editorial Comments: Fighting fires; January 11, 2013 issue, page 19
  • Nigeria: National Emergency Management Agency (NEMA). National focal point. Available @ http: www.un-spider org. network/national-focal points/Nigeria and @ http//www.
  • Ojo J. Overcoming Nigeria’s disaster management challenges. Punch on the web, July 25, 2011 available @ http// 2011/jul25/800.html
  • Olorunfemi FB. Managing Flood Disaster under changing climate: lessons from Nigeria and South Africa; Nigerian Institute of Social and Economic Research (NISER) Discussion Paper No. 1, 2011- Paper presented at NISER Research Seminar Series, NISER, Ibadan, 3rd May, 2011 pp1-43





ON 14TH JULY, 2012