3.1 The provision of international assistance in health

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In all cases, the local community or region provides the immediate response to a disaster. With that in mind, international assistance should target those specific needs and technical problems that the affected country’s available resources are inadequate to address.

In a PAHO guide on providing effective humanitarian assistance in disasters, the following points are key when providing international assistance:

  • National health authorities should rapidly evaluate needs for outside assistance and immediately alert the international community regarding the specific assistance needed, as well as making clear what is not needed. Priorities should be explained, and a distinction made between immediate needs and what is needed for rehabilitation and reconstruction.
  • Humanitarian health aid for disaster situations should be coordinated with personnel designated by the affected country’s ministry of health.
  • Diplomatic and consular missions should make it clear to donor countries that the affected country has firm policies regarding the acceptance of unrequested or unsuitable supplies.
  • PAHO/WHO serves as a coordinating entity for information about health contributions offered and determines what the true health needs are.
  • Countries that request specialized assistance from health experts should make sure that it is actually needed, and should confirm that the personnel have the technical capacity and autonomy needed to operate in existing conditions.

This guide also recommends:

  • Medical and paramedical personnel: Local health services are able to handle emergency medical care to disaster victims. In fact, most countries in Latin America and the Caribbean have a relatively high physician-to-population ratio. If international aid is needed, neighboring countries are in the best position to assist during the immediate after- math of an event. Exceptions to this are highly skilled specialists who have been specifically requested by the Ministry of Health. Foreign medical or paramedical personnel who are unfamiliar with local language and conditions should be encouraged to remain at home.
  • Drugs: The need for the drugs that are offered should be confirmed, shipments verified, and quality and standards checked for consistency with preservation criteria and expiration dates. Pharmaceuticals require a good deal of storage space, may have exceeded their expiration date, and do not have a general positive impact on the disaster situation Drugs that are received need to be classified, and although this is generally done by medical staff, they are needed for far more important post-disaster interventions.
  • Blood and blood derivaties: There is much less need for blood that the public commonly believes. In recent disasters in Latin America, local blood donors in the affected country have covered the victims' needs. Furthermore, sending such items presents major logistical problems, since proper refrigeration and transportation systems are needed, in addition to ensuring beforehand that quality and safety conditions.
  • Food: Generally speaking, there is not a great scarcity of food after a disaster in our Region. Moreover, food donations do not solve the problem of transportation, since roads may be destroyed by events such as earthquakes, landslides, and floods. As regards food, populations with special needs should be targeted (pregnant women, boys, girls, patients living with HIV), and cultural conditions and eating habits should be considered.
  • Field hospitals: Considering that this type of equipment is justified only when it meets medium-term needs, it should not be accepted unless it is donated. Equipment specifications such as weight, volume, freight and installation costs should be transmitted to Ministry of Health authorities so that they can decide on its usefulness. Consult the PAHO/WHO guidelines on field hospitals in the aftermath of sudden-impact disasters.
  • Vaccines: They are most often neither needed nor approved by the cor- responding Ministry of Health. Check the presentation, dose, and expiration date and inform the Ministry of Health, or check with PAHO/WHO. Often, disasters interrupt the cold chain, and this should be factored in before any movement is undertaken.
  • Water and sanitation: Consideration should be given to the high cost of shipping water and certain basic sanitation solutions (latrines or chemical toilets). It is important to analyze the situation on a case-by-case basis, encouraging measures that help provide safe water, solve existing sanitation take into account local resources and labor. There should also be a focus on medium-term sustainability.

The international humanitarian community has made major efforts to improve the quality of donations—drugs, as well as medical equipment and other health supplies—by agreeing on guidelines on good drug donation practices.

Countries have the right to decide what assistance to accept, but they also have the duty to provide guidance to donors on what assistance is most suited to the particular emergency needs. The guide on Be a better donor: practical recommendations on humanitarian donations provides a series of guidelines on aid practices for both recipient countries and donors.

Also, many governments in the Americas have established mechanisms and guidelines for coordinating reciprocal assistance between donor and recipient countries. Examples include the operational guide to mutual assistance in disasters in the Andean countries and the regional manual on procedures of ministries of foreign affairs in disasters, which deals with Central America, Belize and the Dominican Republic. Both of these documents are available in Spanish only.