Recent Disasters and Ethical Issues in Health Recent Disasters and Ethical Issues in Health Management in PakistanManagement in Pakistan

Dr. Badaruddin AbbasiNational Health Emergency Preparedness and Response Network

Pakistan Institute of Medical Sciences, Ministry of Health, Islamabad 44000

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Pakistan

OutlineOutline

Demographics of PakistanDemographics of Pakistan

Overall Disaster SituationOverall Disaster Situation

Disease ThreatsDisease Threats

ResponseResponse

Issues in Health Issues in Health ManagementManagement

PakistanPakistan

Indus Valley CivilizationIndus Valley Civilization

Gandhara CivilizationGandhara Civilization

Islam in Sub ContinentIslam in Sub Continent

People and Places of PakistanPeople and Places of Pakistan

WorldWorld’’s Biggest Necropoliss Biggest Necropolis

WorldWorld’’s Second Highest s Second Highest Peak?Peak?

K2: Second Highest PeakK2: Second Highest PeakAltitude: 28,251 ft

Valleys and PlainsValleys and Plains

First elected Prime First elected Prime Minister women in Minister women in

Muslim world?Muslim world?

Population ProfilePopulation Profile

PopulationPopulation

170 Million 170 Million 

Male / Female ratioMale / Female ratio––

52:4852:48Urban/Rural Urban/Rural ––

33% :  67%33% :  67%

Annual Growth RateAnnual Growth Rate

2.05%2.05%

Area  Area  

796,000 sq. Km.796,000 sq. Km.

Source:

Economic Survey of Pakistan 2009‐10. 

Overall Disaster SituationsOverall Disaster Situations

Pakistan Earthquake Oct 2005Pakistan Earthquake Oct 2005

Magnitude :Magnitude :

7.6 on the Richter Scale 7.6 on the Richter Scale --

30,000 sq Km 30,000 sq Km Affected Area :Affected Area :

30,000 sq Km (Nine Districts 30,000 sq Km (Nine Districts ––

Inhospitable Inhospitable

Terrain) Terrain) Human Loss :Human Loss :

73,338 Dead and &128,304 Severely Injured 73,338 Dead and &128,304 Severely Injured

Physical Loss:Physical Loss:3 .5 Million Rendered Homeless, over 600,000 Houses Destroyed 3 .5 Million Rendered Homeless, over 600,000 Houses Destroyed 5,344 Education Facilities Destroyed 5,344 Education Facilities Destroyed 307 Health Facilities Destroyed 307 Health Facilities Destroyed 715 Government Sector Buildings Damaged 715 Government Sector Buildings Damaged 2,393 Km Roads Damaged 2,393 Km Roads Damaged

After ShocksAfter Shocks

The earthquake affected a The earthquake affected a population of approximately 3.5 population of approximately 3.5 million people either directly or million people either directly or indirectly.indirectly.

In addition to the staggering In addition to the staggering numbers of deaths, the human numbers of deaths, the human cost includes amputees, orphans, cost includes amputees, orphans, unhygienic conditions resulting in unhygienic conditions resulting in disease, and severe malnutrition. disease, and severe malnutrition.

The early days of the disaster The early days of the disaster

response were marked by response were marked by

uncoordinated efforts among a uncoordinated efforts among a whole host of organizations whole host of organizations involved in relief work. involved in relief work.

There was little information on There was little information on who was doing what and little who was doing what and little oversight.oversight.

The Government of Pakistan established The Government of Pakistan established the Earthquake Reconstruction and the Earthquake Reconstruction and Rehabilitation Authority (ERRA) on Rehabilitation Authority (ERRA) on October 24, 2005 to take up the huge task October 24, 2005 to take up the huge task of rebuilding in the earthquake affected of rebuilding in the earthquake affected regions spread over 30,000 square regions spread over 30,000 square kilometers of nine districts of KPK and kilometers of nine districts of KPK and AJ&K. AJ&K.

The Challenge :The Challenge :

Immediate:Immediate:

Rescue and Relief Rescue and Relief

Provision of Emergency Health Care Provision of Emergency Health Care

Long term:Long term:

Reconstruction and Rehabilitation of Destroyed Reconstruction and Rehabilitation of Destroyed Infrastructure Infrastructure

Renewal of Livelihood, Protection of Environment Renewal of Livelihood, Protection of Environment and Rehabilitation of Vulnerable Populationand Rehabilitation of Vulnerable Population

2010 Flood Affected Districts

Damages & Losses (As of March 27, 2011)Damages & Losses (As of March 27, 2011)

DeathsDeaths

1,9851,985

InjuredInjured

2,9462,946

Household damagedHousehold damaged

1,744,4711,744,471

Population affectedPopulation affected

20,184,55020,184,550

Cropped areas (Hectares)Cropped areas (Hectares)

2,244,6442,244,644

District AffectedDistrict Affected

78 78

Source: NDMA Report

National Disaster Management National Disaster Management Authority (NDMA) Act 2010Authority (NDMA) Act 2010

Mission of NDMAMission of NDMA"To manage complete spectrum of disasters by adopting "To manage complete spectrum of disasters by adopting a disaster risk reduction perspective in development a disaster risk reduction perspective in development planning at all levels, and through enhancing institutional planning at all levels, and through enhancing institutional capacities for disaster preparedness, response and capacities for disaster preparedness, response and recovery." recovery."

Disease ThreatsDisease Threats

PrioritiesPriorities

FoodFood

Clean drinking waterClean drinking water

ShelterShelter

NonNon--food itemsfood items

Access to health careAccess to health care

Health ChallengesHealth Challenges

Preserve and restore access to Basic Health Care, Critical ChronPreserve and restore access to Basic Health Care, Critical Chronic ic treatments, and proper wounds and Childhood illnesses treatments, and proper wounds and Childhood illnesses managementmanagement

Sexual and Reproductive Health including FP , Emergency ObstetriSexual and Reproductive Health including FP , Emergency Obstetric c and New Born Careand New Born Care

Referral of life Threatening ConditionsReferral of life Threatening Conditions

Prevention of, detection of and response to outbreaks of Prevention of, detection of and response to outbreaks of communicable diseasescommunicable diseases

Mental health and PsychoMental health and Psycho--Social supportSocial support

Response to acute malnutrition; continuation of breast feeding.Response to acute malnutrition; continuation of breast feeding.

ResponseResponse

The NDMA, has assigned the Ministry of Health with the role of The NDMA, has assigned the Ministry of Health with the role of disaster risk management for the health sector. disaster risk management for the health sector.

In compliance, the Ministry of Health has established the NationIn compliance, the Ministry of Health has established the National al Health Emergency Preparedness and Response Network Health Emergency Preparedness and Response Network (NHEPRN) in March 2010. (NHEPRN) in March 2010.

The headquarter of the Network is based at Islamabad with The headquarter of the Network is based at Islamabad with provincial and district HEPR units. provincial and district HEPR units.

The National HEPR centre has been established by the Ministry ofThe National HEPR centre has been established by the Ministry of Health at the Pakistan Institute of Medical Sciences premises, Health at the Pakistan Institute of Medical Sciences premises,

Islamabad in collaboration with the World Health organization Islamabad in collaboration with the World Health organization (WHO).(WHO).

National Health Emergency Preparedness and National Health Emergency Preparedness and Response Network (NHEPRN).Response Network (NHEPRN).

InterventionsInterventions

Psychosocial support to the affected Psychosocial support to the affected population population

Hygiene promotion interventions Hygiene promotion interventions –– providing water purification tablets, safe providing water purification tablets, safe

water, water chlorination water, water chlorination

Tents for temporary healthcare facilities Tents for temporary healthcare facilities

Strengthening the referral system to higher Strengthening the referral system to higher levels of healthcare levels of healthcare

Vaccination campaignsVaccination campaigns

Maternal and child HealthMaternal and child Health

Establishment of 180 MNCH service delivery Establishment of 180 MNCH service delivery points points

Antenatal servicesAntenatal services

Skilled Birth servicesSkilled Birth services

Postnatal servicesPostnatal services

Family Planning Family Planning

ChallengesChallenges

Malnourishment: high rate of abortions and Malnourishment: high rate of abortions and miscarriagesmiscarriages

Lack/retention of trained Human resource Lack/retention of trained Human resource

Lack of referral mechanism/servicesLack of referral mechanism/services

Criticism of ResponseCriticism of Response

The Government was blamed for sluggish and disorganized responseThe Government was blamed for sluggish and disorganized response

to the to the

floods which led to riots, with looting of aid convoys by hungerfloods which led to riots, with looting of aid convoys by hunger--stricken stricken people.people.

President of Pakistan gone ahead with his visits to meet leadersPresident of Pakistan gone ahead with his visits to meet leaders

in Britain in Britain

and France at a time when his nation was facing catastrophe.and France at a time when his nation was facing catastrophe.

The ruling ministers were accused of using their influence to reThe ruling ministers were accused of using their influence to redirect direct floodwaters from their crops while risking densely populated arefloodwaters from their crops while risking densely populated areas leading as leading Pakistani UN ambassador to call for an inquiry.Pakistani UN ambassador to call for an inquiry.

The United Nations criticized the international community for reThe United Nations criticized the international community for responding sponding slowly, despite the ferocity and magnitude of the disaster. As oslowly, despite the ferocity and magnitude of the disaster. As of 9f 9

August, August,

only $45 million in aid had been committed, which is far less thonly $45 million in aid had been committed, which is far less than usual for an usual for this scale of disaster.this scale of disaster.

British Prime Minister was accused by Pakistan of hampering inteBritish Prime Minister was accused by Pakistan of hampering international rnational aid efforts after he claimed that Pakistan was responsible for paid efforts after he claimed that Pakistan was responsible for promoting romoting terrorism.terrorism.

Issues in Health ManagementIssues in Health Management

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Duties and ObligationsDuties and Obligations

Will health care professionalsWill health care professionalsVolunteer for work in Disasters ?Volunteer for work in Disasters ?

Unlike other professions MedicalUnlike other professions MedicalPersonnel obliges to assist in the Personnel obliges to assist in the relief of Human suffering and relief of Human suffering and alleviation of pain to the extent alleviation of pain to the extent possible. (Oath of Hippocrates).possible. (Oath of Hippocrates).

The extent to which these ethical The extent to which these ethical obligations are universally obligations are universally applicable.applicable.

Needs AssessmentNeeds Assessment

International Donors and NGOs assistance can International Donors and NGOs assistance can occur with the assessment of needs.occur with the assessment of needs.

An assessment that defines a need must be An assessment that defines a need must be followedfollowed--up with appropriate assistance.up with appropriate assistance.

Lack of such appropriate action causes Lack of such appropriate action causes enormous frustration among the affected enormous frustration among the affected population. population.

Neglect of minoritiesNeglect of minorities

It was reported that members of Pakistan's minority It was reported that members of Pakistan's minority communities complained that not only were they not communities complained that not only were they not rescued but in some instances ejected from relief rescued but in some instances ejected from relief camps when their identity was disclosed. camps when their identity was disclosed.

Members of the Sikh community also complained of Members of the Sikh community also complained of government apathy. They said members of their government apathy. They said members of their community were abandoned in Khybercommunity were abandoned in Khyber--Pakhtoonkhwa Pakhtoonkhwa and had to arrange for rescues by themselves.and had to arrange for rescues by themselves.

Protests broke out in Lyari relief camp after Protests broke out in Lyari relief camp after HHindus indus were served beef by the authorities in violation of their were served beef by the authorities in violation of their religious beliefs, which forbade beef consumption. religious beliefs, which forbade beef consumption.

Social Injustice and disrespectSocial Injustice and disrespect

Wealthy feudal influential /politicians not only Wealthy feudal influential /politicians not only diverted funds and resources away from the diverted funds and resources away from the poor but diverted flow of flooding waters away poor but diverted flow of flooding waters away from their Agricultural lands to most populated from their Agricultural lands to most populated towns.towns.

There were also allegations that local There were also allegations that local authorities colluded with the Feudal /Politicians authorities colluded with the Feudal /Politicians to divert funds.to divert funds.

The wealthy, with better access to The wealthy, with better access to transportation and other facilities, suffered far transportation and other facilities, suffered far l h hl th th

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Resource AllocationResource Allocation

Due to limited supplies of safe delivery Due to limited supplies of safe delivery kits, FP methods , vaccines, devices, kits, FP methods , vaccines, devices, Hospital beds, and other items the Hospital beds, and other items the transparency and allocation be ensuredtransparency and allocation be ensured

conclusionconclusion