The document discusses the relief and rehabilitation phases after a disaster. It covers the following key points: In the relief phase, humanitarian aid begins to arrive and includes food, shelter, and medical supplies. A rapid damage assessment is conducted. Disease surveillance and control measures are implemented to prevent outbreaks due to issues like overcrowding. The rehabilitation phase focuses on restoring normal living conditions and services. Priority areas include repairing water systems, ensuring food safety, and implementing vector control programs. Challenges include providing for displaced populations' basic needs, livelihood recovery, and addressing legal/psychosocial issues. Disaster plans and responses are evaluated for effectiveness.

1. 1
‫ج‬
‫ــــ‬
‫امعة‬
‫م‬
‫ــــ‬
‫ؤت‬
‫ـــ‬
‫ة‬
‫كل‬
‫ــ‬
‫ية‬
‫التم‬
‫ــــ‬
‫ريض‬
DISASTER AND EMERGENCY NURSING
Mutah University
Faculty of Nursing
Reliefandrehabilitation

2. Relief phase
 This phase begins when assistance from
outside starts to reach the disaster area.
 The type and quantity of humanitarian relief
supplies are usually determined by two
main factors :
 (1) the type of disaster, since distinct events have
different effects on the population,
(2) the type and quantity of supplies available
locally.
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3. Relief phase
 Following the initial emergency phase,
needed supplies will include food, blankets,
clothing, shelter, sanitary engineering
equipment and construction materials.
 A rapid damage assessment must be
carried out in order to identify needs and
resources.
 Disaster managers must be prepared to
receive large quantities of donations.
 Epidemiologic surveillance and disease
control.
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4. Managing humanitarian supplies:
 There are four principal
components in managing
humanitarian supplies:
 (a) acquisition of supplies;
 (b) transportation;
 (c) storage; and
 (d) distribution.
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5. Relief phase
 Disasters can increase the
transmission of communicable diseases
through following mechanisms :
1. Overcrowding and poor sanitation in
temporary resettlements. This accounts in
part, for the reported increase in acute
respiratory infections etc. following the
disasters.
2. Population displacement may lead to
introduction of communicable diseases to
which either the migrant or indigenous
populations are susceptible.
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6. Relief phase
3. Disruption and the contamination of water supply,
damage to sewerage system and power systems
are common in natural disasters.
4. Disruption of routine control programmes as funds
and personnel are usually diverted to relief work.
5. Ecological changes may favour breeding of vectors
and increase the vector population density.
6. Displacement of domestic and wild animals, who
carry with them zoonoses that can be transmitted
to humans as well as to other animals.
7. Provision of emergency food, water and shelter in
disaster situation from different or new source may
itself be a source of infectious disease.
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7. Relief phase
 Outbreak of gastroenteritis, which is the most
commonly reported disease in the post-disaster
period, is closely related to first three factors
mentioned above.
 Increased incidence of acute respiratory infections
is also common in displaced population. Vector-
borne diseases will not appear immediately but
may take several weeks to reach epidemic levels.
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8. Risk from animals
 Displacement of domesticated and wild
animals increases the risk of transmission of
zoonoses. Veterinary services may be needed
to evaluate such health risks.
 Dogs, cats and other domestic animals are
taken by their owners to or near temporary
shelters.
 Some of these animals may be reservoirs of
infections such as leptospirosis,
rickettsiosis etc.
 wild animals are reservoirs of infections which
can be fatal to man such as equine
encephalitis, rabies, 8

9. Principles of controlling communicable
diseases
 The principles of preventing and controlling
communicable diseases after a disaster are
to:
(a) implement as soon as possible all
public health measures, to reduce the
risk of disease transmission;
(b) (organize a reliable disease reporting
system to identify outbreaks and to
promptly initiate control measures; and
(c) investigate all reports of disease
outbreaks rapidly.
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10. Vaccination
 Health authorities are often under considerable
public and political pressure to begin mass
vaccination programmes, usually against typhoid,
cholera and tetanus. The pressure may be
increased by the press media and offer of vaccines
from abroad.
 The WHO does not recommend typhoid and cholera
vaccines in routine use in endemic areas. The
newer typhoid and cholera vaccines have increased
efficacy, but because they are multidose vaccines,
compliance is likely to be poor.
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11. Vaccination:
 Vaccination programme requires large number of
workers who could be better employed elsewhere.
Supervision of sterilization and injection
techniques may be impossible, resulting in more
harm than good. And above all, mass vaccination
may lead to false sense of security about the risk
of the disease and to the neglect of effective
control measures. However, these vaccinations
are recommended for health workers.
 Supplying safe drinking water and proper disposal
of excreta continue to be the most practical and
effective strategy.
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12. Vaccination:
 Significant increases in tetanus incidence have not
occurred after natural disasters. Mass vaccination
of population against tetanus is usually
unnecessary.
 Natural disasters may negatively affect the
maintenance of on going national or regional
eradication programmes against polio and
measles. Disruption of these programmes should
be monitored closely.
 If cold-chain facilities are inadequate, they should
be requested at the same time as vaccines. The
vaccination policy to be adopted should be decided
at senior level only
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13. Nutrition:
 A natural disaster may affect the nutritional
status of the population by affecting one or more
components of food chain depending on the type,
duration and extent of the disaster, as well as the
food and nutritional conditions existing in the
area before the catastrophe.
 Infants, children, pregnant women, nursing
mothers and sick persons are more prone to
nutritional problems after prolonged drought or
after certain types of disasters like hurricanes,
floods, land or mudslides, volcanic eruptions and
sea surges involving damage to crops, to stocks
or to food distribution systems.
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14. Nutrition:
The immediate steps for ensuring that the food
relief programme will be effective include:
A. assessing the food supplies after the
disaster;
B. gauging the nutritional needs of the
affected population;
C. calculating daily food rations and need for
large population groups;
D. monitoring the nutritional status of the
affected population.
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15. Rehabilitation
The final phase in a disaster should lead
to restoration of the pre-disaster
conditions.
 Rehabilitation starts from the very first moment
of a disaster. Too often, measures decided in a
hurry, tend to obstruct establishment of normal
conditions of life.
 A provision by external agencies of sophisticated
medical care for a temporary period has negative
effects. On the withdrawal of such care, the
population is left with a new level of expectation
which simply cannot be fulfilled.
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16. Rehabilitation
 In first weeks after disaster, the pattern of health
needs, will change rapidly, moving from casualty
treatment to more routine primary health care.
 Services should be reorganized and restructured.
 Priorities also will shift from health care towards
environmental health measures. Some of them are
as follows:
 Water supply
 Food safety
 Vector control
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17. Rehabilitation: Water supply
 A survey of all public water supplies should be made. This
includes distribution system and water source.
 It is essential to determine physical integrity of system
components, the remaining capacities, and bacteriological
and chemical quality of water supplied.
 The main public safety aspect of water quality is microbial
contamination.
 Chemical contamination and toxicity are a second concern in
water quality and potential chemical contaminants have to be
identified and analyzed
 The first priority of ensuring water quality in emergency
situations is chlorination. It is the best way of disinfecting'
water. It is advisable to increase residual chlorine level to
about 0.2-0.5 mg / litre.
 Low water pressure increases the risk of infiltration of
pollutants into water mains.
 Repaired mains, reservoirs and other units require cleaning
and disinfection.
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18. Rehabilitation: Water supply
The existing and new water sources require the
following protection measures :
1. restrict access to people and animals, If possible,
erect a fence and appoint a guard.
2. ensure adequate excreta disposal at a safe
distance from water source.
3. prohibit bathing, washing and animal husbandry,
upstream of intake points in rivers and streams.
4. upgrade wells to ensure that they are protected
from contamination.
5. estimate the maximum yield of wells and if
necessary, ration the water supply.
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19. Rehabilitation: Water supply
 In many emergency situations, water has
to be trucked to disaster site or camps.
 All water tankers should be inspected to
determine fitness, and should be cleaned
and disinfected before transporting water.
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20. Rehabilitation: Food safety
 Poor hygiene is the major cause of food-borne
diseases in disaster situations. Where feeding
programmes are used (as in shelters or camps)
kitchen sanitation is of utmost importance. Personal
hygiene should be monitored in individuals involved in
food preparation.
 Basic sanitation and personal hygiene; Many
communicable diseases are spread through faecal
contamination of drinking water and food such as:
(cholera, typhoid, hepatitis A, polio) .
 Every effort should be made to ensure the sanitary
disposal of excreta.
 Emergency latrines should be made available to the
displaced, where toilet facilities have been destroyed.
 Washing, cleaning and bathing facilities should be
provided to the displaced persons. 20

21. Rehabilitation: Vector control
 Control programme for vector-borne
diseases should be intensified in the
emergency and rehabilitation period,
especially in areas where such diseases are
known to be endemic.
 Of special concern are dengue fever and
malaria (mosquitoes), leptospirosis and rat
bite fever (rats), typhus (lice, fleas), and
plague (fleas).
 Flood water provides ample breeding
opportunities for mosquitoes.
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22. Rehabilitation: displaced population
 A major disaster with high mortality leaves a
substantial displaced population, among whom
are those requiring medical treatment and
orphaned children.
 When it is not possible to locate the relatives
who can provide care, orphans may become
the responsibility of health and social agencies.
 Efforts should be made to reintegrate disaster
survivors into the society, as quickly as
possible through institutional programmes
coordinated by ministries of health and family
welfare, social welfare, education, and NGOs.
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23. Challenges of rehabilitation:
1. Ensuring that people living in the relief
camps have access to:
 Regular food supplies
 Additional sets of clothes
 Sanitation drinking water,
 Public health intervention – immunization
 Heat and rain proof shelters
 Child care and education facilities and support.
2. Ensuring access to basic entitlements in terms of
their compensation, government schemes and
credit institutions so that they can rebuild their
homes and livelihood back to the some levels as
before the disaster.
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24. Challenges of rehabilitation:
3. Ensuring livelihood reintegration.
4. Ensuring legal right and social justice to the
disaster victims including filing of First
Information Reports (FIRs), investigation
and contesting cases in the court.
5. Providing psychosocial counselling and
support for dealing with loss, betrayal and
anger.
6. Community based care/rehabilitation for
widows orphans, elderly, children and
physically disabled.
7. Actively rebuilding a culture of communal
harmony and trust. 24

25. Evaluate effectiveness of disaster
plan
 Critically evaluate all aspects of disaster
plans and practice drills for speed,
effectiveness, gaps and revisions.
 Evaluate the disaster impact on community
and surrounding regions.
 Evaluate the response of personnel
involved in disaster relief efforts.
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26. THANK YOU
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