Editorial
Captured in satellite images, the immense white storm mass barrelled toward the archipelago that is the Philippines. It was soon evident that Super Typhoon Haiyan was to wreak tremendous physical destruction and human devastation on this nation of islands. Like most natural disasters or humanitarian crises, an all too familiar sequence of events followed: the shocking damage and loss of life, fear and chaos, lack of food and shelter, emergence of disease, sluggish response from local and international governments, and finally difficulties of rebuilding infrastructure and lives. As the situation in the Philippines develops and challenges continue to emerge, the need to examine and improve responses to complex humanitarian emergencies is paramount. A first step is to quantify the magnitude and scope of the public health impact of a complex humanitarian emergency. The Sphere Project, which launched in 1997, proposed a set of four categories of minimum standards for responding, including health, shelter, food and nutrition, and water and sanitation—a set of objective metrics to inform response scale and to monitor progress. By these metrics, storm survivors in the Philippines have been drastically affected. The death toll hovers around 4000 people, at least 3 million people have been displaced, food and potable water shortages are widespread, and reported cases of diarrhoea and tetanus continue to rise. Compounding the disease threat is the destruction of clinics, especially in remote regions, and shortages of medicine and vaccine. In reaction to the criticism that it has not acted quickly enough, the Government in the Philippines has claimed that response orchestration is not the problem, but that lack of supplies has hampered the disaster response. Previous humanitarian emergencies illustrate the potential threats that political discord and other social determinants can do to impede relief efforts. A recent analysis of what might be learned from the 2011 famine in Somalia offered a set of five criteria that must be met for the swift resolution of humanitarian crises. Within challenging political environments especially, for successful intervention during a crisis, a humanitarian agency must have a physical presence, access to those in need of aid that is not obstructed by political or militant groups, scalable capacity to operate, adequate funding, and legal protection. Although it reads more like a wish list than www.thelancet.com Vol 382 November 23, 2013
a reality, working to achieve this humanitarian response scheme in high-risk areas is a foundational measure for improving the speed and success of disaster and emergency responses. Simply put, gaps in this formulation equate to sustained human suffering and loss of life. Even with much of this framework pre-existing in the Philippines, along with the financial and tactical support of the UK, USA, and Australia, among others, stabilisation of the situation is likely to take much longer than our best estimates. Effective disaster response must necessarily focus on the acute crisis, but also take into account the recovery period and the long-term protection of individuals. Painful reminders of the protracted effects of disasters abound. Even a year after Cyclone Nargis, which killed 138 000 people in Burma in 2008, survivors continued to suffer a host of human rights violations, from inadequate nutrition and shelter to gender-based violence. Human rights violations also disproportionately affect the most vulnerable individuals, such as those with mental illness, who experience stigma and limited access to resources under normal conditions and can become further neglected and maltreated under bad ones. A 2009 paper in The Lancet examines potential solutions for protecting people with severe mental disorders during crises, with a call to raising awareness and improving systems for administering care during emergencies. By contrast, as explored in a paper in a new Lancet Series, Bangladesh is an example of a country that has found ways to mitigate geographical vulnerability to natural disaster through successful planned interventions, such as wider availability of technology and disaster resilient habitats. By learning from previous disasters and committing to country-wide improvements, morbidity and mortality have been greatly reduced. It is far too simple to say that relief efforts during complex humanitarian emergencies must improve. It is imperative, however, that the global community works toward streamlining viable systems for increasing the speed and efficacy of responses during crises. With a considerable evidence base of previous failures and shortcomings coupled with well-defined monitoring methodology, a great opportunity to learn as we go exists in the relief efforts underway in the Philippines. Disasters are inevitable, and the need to strategically allay human suffering is certain. The Lancet
Philippe Lopez/Staff
The Philippines: learning lessons from past disasters
See Online/Series Lancet 2013; published online Nov 21. http://dx.doi. org/10.1016/S01406736(13)61948-0
For the 2009 Lancet paper on severe mental disorders in complex emergencies see Health Policy Lancet 2009; 374: 654–61
1679
Captured in satellite images, the immense white storm mass barrelled toward the archipelago that is the Philippines. It was soon evident that Super Typhoon Haiyan was to wreak tremendous physical destruction and human devastation on this nation of islands. Like most natural disasters or humanitarian crises, an all too familiar sequence of events followed: the shocking damage and loss of life, fear and chaos, lack of food and shelter, emergence of disease, sluggish response from local and international governments, and finally difficulties of rebuilding infrastructure and lives. As the situation in the Philippines develops and challenges continue to emerge, the need to examine and improve responses to complex humanitarian emergencies is paramount. A first step is to quantify the magnitude and scope of the public health impact of a complex humanitarian emergency. The Sphere Project, which launched in 1997, proposed a set of four categories of minimum standards for responding, including health, shelter, food and nutrition, and water and sanitation—a set of objective metrics to inform response scale and to monitor progress. By these metrics, storm survivors in the Philippines have been drastically affected. The death toll hovers around 4000 people, at least 3 million people have been displaced, food and potable water shortages are widespread, and reported cases of diarrhoea and tetanus continue to rise. Compounding the disease threat is the destruction of clinics, especially in remote regions, and shortages of medicine and vaccine. In reaction to the criticism that it has not acted quickly enough, the Government in the Philippines has claimed that response orchestration is not the problem, but that lack of supplies has hampered the disaster response. Previous humanitarian emergencies illustrate the potential threats that political discord and other social determinants can do to impede relief efforts. A recent analysis of what might be learned from the 2011 famine in Somalia offered a set of five criteria that must be met for the swift resolution of humanitarian crises. Within challenging political environments especially, for successful intervention during a crisis, a humanitarian agency must have a physical presence, access to those in need of aid that is not obstructed by political or militant groups, scalable capacity to operate, adequate funding, and legal protection. Although it reads more like a wish list than www.thelancet.com Vol 382 November 23, 2013
a reality, working to achieve this humanitarian response scheme in high-risk areas is a foundational measure for improving the speed and success of disaster and emergency responses. Simply put, gaps in this formulation equate to sustained human suffering and loss of life. Even with much of this framework pre-existing in the Philippines, along with the financial and tactical support of the UK, USA, and Australia, among others, stabilisation of the situation is likely to take much longer than our best estimates. Effective disaster response must necessarily focus on the acute crisis, but also take into account the recovery period and the long-term protection of individuals. Painful reminders of the protracted effects of disasters abound. Even a year after Cyclone Nargis, which killed 138 000 people in Burma in 2008, survivors continued to suffer a host of human rights violations, from inadequate nutrition and shelter to gender-based violence. Human rights violations also disproportionately affect the most vulnerable individuals, such as those with mental illness, who experience stigma and limited access to resources under normal conditions and can become further neglected and maltreated under bad ones. A 2009 paper in The Lancet examines potential solutions for protecting people with severe mental disorders during crises, with a call to raising awareness and improving systems for administering care during emergencies. By contrast, as explored in a paper in a new Lancet Series, Bangladesh is an example of a country that has found ways to mitigate geographical vulnerability to natural disaster through successful planned interventions, such as wider availability of technology and disaster resilient habitats. By learning from previous disasters and committing to country-wide improvements, morbidity and mortality have been greatly reduced. It is far too simple to say that relief efforts during complex humanitarian emergencies must improve. It is imperative, however, that the global community works toward streamlining viable systems for increasing the speed and efficacy of responses during crises. With a considerable evidence base of previous failures and shortcomings coupled with well-defined monitoring methodology, a great opportunity to learn as we go exists in the relief efforts underway in the Philippines. Disasters are inevitable, and the need to strategically allay human suffering is certain. The Lancet
Philippe Lopez/Staff
The Philippines: learning lessons from past disasters
See Online/Series Lancet 2013; published online Nov 21. http://dx.doi. org/10.1016/S01406736(13)61948-0
For the 2009 Lancet paper on severe mental disorders in complex emergencies see Health Policy Lancet 2009; 374: 654–61
1679
