Neglected issues in health care

1. Emergency rapid needs assessment. This should focus on basic health needs, including needs assessment for food, water, sanitation, and shelter. There must be attention to an equitable distribution of these resources, and special attention to the vulnerable populations as defined above.

2. Mental health. Emphasis was made on efforts to "normalize the life of individuals, families and communities" in terms of livelihoods, schooling, and housing. Psychological support should not be restricted to medical practitioners, since only a minority of those affected actually requires this level of professional help. It was recommended that the WHO develop guidelines for the use of psychotropic medications in the setting of natural disasters.

3. Management of mass casualties. The areas affected by the tsunami appeared to be unable to manage large numbers of casualties due to the lack of standardized triage, of a pre-established network of health-care facilities for sharing the burden, and of appropriate plans for allocation based on expertise. The immediate health-care assistance to those who were injured was usually provided by someone else who was injured, indicating the need for public education in first aid techniques. Particularly important was the special role played by the National Red Cross and Red Crescent societies, and the collaborative interactions of these groups with local health authorities and the WHO.

4. Forensic issues. As noted, there were excessive human resources devoted to handling of dead bodies, under the erroneous impression that these generate disease. The appeal was to avoid rushing to bury or cremate rapidly, since this detracts from the requirements of the living and the need to respect cultural factors such as grieving, proper burial, etc. However, there was also emphasis on the need for a rapid method for body storage facilities.

5. Benchmarks, standards and ethics. Ethical standards have been established by the Sphere Project (WHO), which has provided standards for health care, including a document on "Standardized Monitoring and Assessment of Relief and Transitions Initiative." Nevertheless, there was an impression that, although standards are available, the tsunami experience highlighted the gap between what is desirable and what happens in actual practice. The greatest concern was that different organizations used different measurements, methods, and interpretations, so that it was difficult to compare results, establish priorities or achieve consensus. This emphasizes the need for standardized assessment and reporting, and the request was that the WHO take leadership in such a guidance document. Another need was guidance in health-care standards, with a curriculum for training institutions.

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