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Practical experiences of post disaster management in Gujarat
Joy I. Cheenath1 and D.P.Solanki2
A series of powerful earthquakes struck Gujarat in western India on 26th January 2001 at
08.50 hours. The tremors were felt across several states as well as in Delhi and Mumbai
and in the Pakistan. The epicenter of the quake was 30 km. North of the town of Bhuj, the
headquarter of Gujarats Kutch district, while at the same time seriously affecting all the
area within a range of 100 km. from the epicenter including Ahmedabad. Infrastructure
was severely damaged resulting in large-scale collapse of buildings, train derailments,
power failure and cutting off the water supply. A series of aftershocks (more than 400
with few of them measuring over 5 on the Richter scale) kept the population and the
authorities on constant alert for quite some time. The initial challenges in post disaster
time were posed by complete breakdown of communication systems and inadequate
information management.
The essential steps in early disaster management relief included prompt response, rapid
assessment and mobilization of multi-disciplinary teams for clinical care. On 27th
January, 46 medical teams including special teams (orthopedic team etc.) had been
mobilized at various points in the affected parts of Gujarat. By the 4th day, there were 160
specialists operating in 4 talukas and every village had been visited atleast once. The
administrative powers of Health Commissioner were delegated to local representatives in
Kutch district.
The following four categories of resources were mobilized in the four most affected
districts:
vehicles;
staff;
facilities;
medications and equipment.
The state of Gujarat could have managed 80% of the resource mobilization task itself
with its available doctors, para-medics, vehicles etc. However, the collapse of hospital
buildings posed a great challenge in organizing medical treatment points. 256 teams of
doctors and approximately 600 specialist had to work in extremely difficult situation. In
order to lessen the burden, a system of regular replacement of the working staff and
doctors was adopted. 2 senior medical persons were deployed in each taluka for a period
of 10 days after which they were replaced by another team. Similarly, specialists worked
at a place for 10 days before being replaced.
The government doctors were mobilized into relief services through mobile medical
teams. There was deployment of roaming vehicles for public information.
The efforts of foreign medical teams need to be acknowledged and lauded for their
significant contribution during the post disaster period. The management of hospitals was

handed over to the Indian Medical Association (IMA) and assistance in terms of
equipment, doctors, nurses etc. was provided to them. Similarly, hospitals at different
locations were handed over to WHO. The local management of medical teams and
partnership with WHO has been recognized as the main strength of health sector
mobilization in the post disaster period.
Weekly or bi-weekly meetings, as required, for district awareness were carried out in the
field. UNICEF and FPA were actively involved in looking after the aspects of mental
health, orthopedic operations etc.
It was realized that it is essential to maintain a continuous flow of communication in
terms of complete and authentic information between senior officers and the field
managers. The donors should be adequately informed about the requirements of the field
and the precise timeframe of their need.
The contingency plan for disaster preparedness should be refined, incorporating details of
deployment of NGOs, international agencies etc., in collaboration with local
administration and other agencies.
In order to avoid the spread of epidemics in monsoon period, the concept of village
surveillance has been adopted in the affected parts of Gujarat.
Summary
Johanna Larusdottir1, David A. Bradt2 and Secretariat
Mr. Anil Sinha, Head, National Center for Disaster Management, IIPA, New Delhi,
India, presented an overview of the earthquake in Gujarat. He informed that the
immediate relief by the Indian federal and state government included release of financial
resources, relief materials and equipment, personnel and relaxation of overdraft
regulation scheme. Further, the army was mobilized with huge amount of equipment.
However, in the aftermath of the earthquake, the efficiency and coordination of the
response mechanism of the civil administration was hampered due to lack of specialized
human resource and stet of the art equipment and machinery. Further, absence of
automatic activation of the disaster management system was the main handicap of the
civil administration system. He mentioned that one of the main reasons for slow response
after the quake was lack of credible information from the affected areas.
He emphasized the need to structure and calibrate the civil disaster management plan so
that the armed forces are requisitioned only when the scale of disaster is beyond the
resources and capabilities of the civil administration. He stressed the need for first
responders, police, emergency medical systems to be well trained, properly equipped,
well coordinated and have rapid search and rescue capability. He also outlined the need to
promote disaster resistant designs and constructions to withstand future disasters. He
mentioned that response mechanism following a disaster can be made more effective by
the use of Geographic Information System (GIS). A database and a system of regularly

updating maps should be developed for the various administrative units of the country.
Dr. G.S. Sandhu, Wing Commander, Indian Air Force, Military Hospital, Bhuj, Gujarat,
India, made a presentation on "Practical problems in the management of mass casualties
during Gujarat earthquake". Dr. Sandhu introduced his presentation by outlining the post
disaster scenario in Gujarat. He mentioned that there was a total collapse of local health
command and control structure. As a consequence, the military hospital whose role was
to supplement civil services had to serve as a first responder. He stated that unplanned
inflow of unprepared health personnel into the disaster area without any means to support
themselves in terms of shelter, food or water posed a major problem. Inflow of medical
supplies, in many cases not need based, was a major management problem due to
inappropriate donations and absence of a supply management system.
He stressed that the health authorities and health professionals need to ensure that
mitigation methodologies are applied during the reconstruction of health facilities.
Coordination and health disaster management is essential and there should be special
equipped space and personnel for this purpose. He also emphasized the importance of
training health professionals to deal with media during disasters.
Mr. Ashok Bhargava, Director, Institute for Development Education & Learning,
Abhiyan, Ahmedabad, Gujarat, India, made his presentation on "Lessons from Gujarat
earthquake: experience of NGOs". He described the efforts of "Abhiyan", which is a
collaboration 22 Kutch based NGOs, in the aftermath of the Gujarat earthquake. He
mentioned that the NGO collaboration did a preliminary survey of 360 villages and
conducted periodic assessment including analysis of health situation, the outcome of
which were regularly fed back to the government health department.
He stated that there was a general lack of information and awareness about high
seismicity and its implications among all sections of the society which resulted in a lack
of preparedness for dealing with disasters and planning for post-disaster management. He
stressed the need to include disaster mitigation and health promotion in school curriculum
at all levels and of health profession. Mr. Bhargava added that the examples of best
practices in disaster management should be documented for future reference and
guidance.
Dr. Joy I. Cheenath, Commissioner, Health, Medical Services & Medical Education,
Government of Gujarat, Gujarat, India and Dr. D.P.Solanki, Chief, District Health
Office, Bhuj, Kutch, Gujarat, India in their presentation on "Practical experiences in post
disaster management in Gujarat" talked about the challenges of post disaster management
and the essential steps taken in early disaster relief management in Gujarat. The critical
importance of coordination of the various actors in a post disaster scenario was
mentioned. The ongoing administrative concerns include refinement of contingency plan
and epidemic preparedness due to advent of monsoons.

Reports from the Working Groups


During the meeting five working groups met to discuss the five critical issues in the
aftermath of an earthquake: mass casualty management, disease surveillance and
response, water and sanitation, coordination of health activities in the relief sector and
psychosocial aspects. The resource persons and the facilitators of the five working groups
presented their summary reports to a plenary session.
Report from the Working Group on Mass Casualty Management
Introducing the issue
The classical management of mass casualty scenario includes search and rescue, triage,
field stabilization, transportation to hospital care and redistribution to tertiary care / other
hospitals. This classical approach may be modified depending upon the magnitude of the
disaster, the prevailing local conditions and the availability of resources.
Conclusions
Use of technology
High technology has a limited role in a disaster situation. Emphasis should be on daily
emergency response in local health facilities. Satellite mapping may be useful in
assessing disaster impact.
Functions of mass casualty management center
The mass casualty management center should coordinate the activities of casualty
treatment (in field and in hospital), logistics management, information and
communication management, casualty redistribution to different hospitals, security and
crowd control, biomedical waste disposal and salvation of medical equipment and stores.
Community awareness programs
Educational and training programs must be formulated to make the community aware of
the methods to deal with disaster situations. International help may be sought for
obtaining technical expertise ad guidance in formulating such programs. The groups to be
targeted may include students, voluntary workers, NGOs, community representatives,
paramedics, police personnel and fire brigade personnel.
The school curricula must incorporate a chapter of guidelines of how to react and cope
with those natural disasters to which the community is at risk.

Report from the Working Group on Disease Surveillance and Response


Introducing the issue
The working group felt that the issue of disease surveillance and response is a function of
standard definitions which can aid in predicting the outbreak to act as an early warning
signal ensuring prompt action from the concerned authorities. The priority conditions
include outbreak of any communicable disease, mass injury, nutritional problems and
mental health disorders. The disaster prone countries should give high priority to disease
surveillance and response as an integral part of disaster preparedness.
Conclusions
Strengthening of disease surveillance system
A reliable disease surveillance system should be strengthened at the different levels of a
disaster management system. These levels include rapid response, early warning system
and information system.
Ways to strengthen the disease surveillance system
The disease surveillance system can be strengthened in the following ways:
Identification of priority health problems.
Standardizing the format for response.
Feedback at all levels from PHC to the national level based on analysis, interpretation
and evaluation of data.
Creation of better laboratory services.
Capacity building including training, coordination and management of information.
Guidelines
Guidelines should be evolved which focus on managing common concerns like disposal
of human and animal carcasses, immunization, monitoring of nutritional standards and
mental health.
Report from the Working Group on Water and Sanitation
Introducing the issue
Safe drinking water supply and basic environmental sanitation are pre requisites to ensure
the health and well being of the communities. They play an important role in prevention
of avoidable diseases, process of development and restoration of normalcy. It is therefore

essential that high priority be accorded to provision of drinking water and basic
sanitation, in the disaster preparedness plan of the health sector.
The working group on water and sanitation deliberated the issue keeping in background
the recent Gujarat earthquake and came out with some broad recommendations as a
guideline to help prepare the disaster preparedness plan.
Conclusions
Technical issues for providing drinking water
Reliability of source It is to be ascertained that the source of water supply available in
the vicinity has acceptable quality and adequate quantity. If not, then provision to
import water from other areas should be planned.
Storage facilities For equal and timely distribution of water to the community, public
storage facility like cistern or HDPE tank should be made available.
Portable purification plants To ensure a standard quality of water, water treatment like
removal of turbidity, bacteria etc. may be required. Portable water purification plants
may be useful. Chlorination plant / device will be most essential.
Provision of tankers Water tankers should be required to carry water to the areas
where local sources are not available or reliable.
Training of staff Training of staff will be most useful to carry out the job efficiently
and effectively.
Technical issues for sanitation
Provision of latrines For excreta disposal, low cost pit latrines will be required
especially for temporary shelters and should be incorporated in permanent shelter plan.
Trash collection Bins and trolleys will be required to collect solid wastes from the
communities and transportation of the disposal of the same.
Washing facilities Wash basins and bathrooms will be necessary to provide personal
cleaning facilities.
Disposal of wastewater Drainage or piping facilities will be essential to dispose the
wastewater generated by the community.
Health education Community will have to be educated for health and hygiene
promotion.
Vector control Spraying of insecticides will be required to control vector, flies and
pest.
Capacity building
Measures should be taken for capacity building at all levels ranging from the Ministry of
Health to the field level. Intercountry technical collaboration should be availed for the

same.
Assessment
Sectoral assessments should be made of the services available at the national, state and
local levels. At the local level, it should entail carrying out vulnerability analysis of water
and sanitation services. The priorities for the action plan should be based on these
assessments.
Political commitment
It is imperative to ensure political commitment at the national, state and local level
towards resources and action for effective implementation of various disaster mitigation
and preparedness plans.
Report from the Working Group on Coordination of Relief Activities in the Health
Sector
Introducing the issue
Numerous agencies are involved in the relief activities in the health sector. It is an intersectoral and inter level discipline and beyond the purview of a single agency or level.
There are different role players involved in the relief and response activities at the
community, taluka, district, state and national level. There is usually a duplication of
effort by the agencies at these levels, which is also often seen in UN agencies efforts.
Thus, it is of paramount importance to sort out the issue of duplication of activities and it
can be achieved by coordination among the various agencies active in a disaster scenario.
Medical response and relief along with essential support for human health should also be
taken care of in a coordinated fashion.
Conclusions
Health coordination system
Health coordination system in a disaster situation should be immediately implemented at
the central and field level and must include all public health topics (disease surveillance
system, food, water, sanitation, shelter etc.). There should also be a provision for
developing the coordination mechanism and the contingency plans at the community
level.
Implementation of health coordination system

The state government in collaboration with WHO should lead the health coordination
system at the central and field level. All the major national and international role players
in providing health aid should perform their activities under the government WHO
coordination.
Assessment
A liable assessment of the situation during various stages of disaster should be carried out
and community health workers should be trained in these efforts.
Planning
The health sector activities may be privatized in overall national disaster management
plan at policy planning, managerial and operational level. The national and state level
contingency plan should cater to the community level needs.
Report from the Working Group on Psychosocial Aspects
Introducing the issue
The great majority of people who experience a disaster have psychosocial responses
which are ordinary reactions to extraordinary events, rather than exhibiting
psychopathology. Emotions such as anxiety, depression and anger, physical reactions
such as gastrointestinal disorders, and cognitive interference may be exaggerated but are
common reactions to the traumatic stress of disaster. Most of these reactions need not be
treated as illnesses requiring clinical treatment. These reactions can be supported in the
context of the community but these community capacities need to be supported in
disaster preparedness.
It is natural for people living in disaster prone areas to have a sense of anxiety about
impending disasters. In order to ameliorate some of these anxieties, it is advisable for the
community / health sector / government to invest not only in physical disaster
preparedness but also in psychosocial preparedness.
Conclusions
Preparing community for disasters
Individual & Family
Training regarding psychological first aid should be developed to capacitate families and
neighbors to take care of themselves in the face of adversity.
Community

At the community level, local support system should be developed along with
empowering the local government. Media can play a vital role in disseminating
information about psychosocial responses to disaster and psychosocial preparedness.
Therefore, the media should be educated about the importance of psychosocial issues in
disaster. It can be utilized as advocacy champions for overall disaster preparedness,
which can increase a communitys sense of security. The media can also be utilized
Health Sector
Community-based psychosocial programs (Psychological First Aid) should be promoted
in the health sector. A module on psychosocial responses to traumatic stress should be
integrated in the training of health personnel at all levels.
Government
The government should advocate for the prioritization of psychosocial disaster
preparedness in the overall scheme of disaster preparedness. It should also advocate for
integration of disaster psychology in education/school curriculum and inclusion of
psychosocial preparation in adolescent health programs. The existing international
psychological first aid models for specific countries and cultures can also be adopted.
International Community
The international community can significantly contribute in the realm of technical
consultation and resource support (training, models, and modules for local adaptation).
Preparedness to address psychosocial needs in a post disaster situation
It is also useful to examine how to meet the psychosocial needs of the community in the
different stages after a disaster.
Immediate (catastrophic)
The community support systems should be put into action (activate Psychological First
Aid volunteers).
Intermediate (reality)
At this stage, the community psychosocial needs should be assessed and the community
support should be continued as an important part of psychosocial support services.
Long-term (frustration)

The psychosocial needs of adversely affected vulnerable groups can be met in the
following manner:
Children: Child counseling services, innovative and educational activities
Women: Womens support groups
People who have lost their livelihood: Retraining/Occupational therapy
Summary
Vijay Kumar1
Presentations were made to summarize the findings and the key recommendations on a)
mass casualty management, b) disease surveillance and response, c) water and sanitation
d) coordination of activities in the health sector and e) psychosocial aspects.
The key elements of mass casualty management include search and response operations,
use of triage system, field stabilization and transportation of very sick patients to
appropriate hospital facilities. Application of high technology has a limited role. The field
operations comprise providing immediate relief through static facilities supplemented by
mobile support. Satellite mapping can be very useful in mapping disaster impact. Simple
standard operating procedures using common language are needed. These should include
guidelines on management of life threatening conditions describing standard treatment
guidelines and standard sterilizing procedures. Mass casualty management is facilitated
by mapping of resources. Education and training programs should be formulated to
involve students, communities, NGOs, paramedics, police and army personnel to enhance
the capacity development in disaster preparedness.
Supply of safe and adequate drinking water nd provision of basic environmental
sanitation services for the communities are essential prerequisites to ensure the health and
well being of the people. It also plays an important role in the prevention and
development activities. It is therefore most desirable that priority is accorded to provision
of safe water and basic sanitation facilities in any disaster preparedness planning.
Disease surveillance, early warning system and availability of base line information on
communicable diseases, nutritional problems, psychosocial problems and injuries are
essential. Availability of information (from the government, private doctors and NGOs),
analysis and feedback at all levels is a basic requirement for effective disease surveillance
and response. During disasters, reporting needs to be simplified and shared frequently for
prompt and timely action. Capacity building through education of the public, training,
laboratory support should be taken up on a priority basis. Guidelines are needed to make
decisions on commonly asked questions like disposal of carcasses, mass immunization
for cholera prevention and monitoring of uncommon outbreaks.
Coordination of relief activities in the health sector should focus on major public health
concerns like disease surveillance, food, water and sanitation, first aid and psychosocial
problems. Local communities need to be fully involved since their contribution forms the
backbone of the outcome. International help can appropriately support this wherever

required. In order to have effective coordination, suitable focal points at all levels with
clearly defined responsibilities must be identified.
Disaster management an attempt to holistic planning
The HPC has identified thirty odd disasters and has grouped them into 5 categories based on generic
considerations.

TABLE 4.1. Table of disasters identified


1. Water and climate related disasters
Floods and drainage management
Cyclones
Tornadoes and hurricanes
Hailstorm
Cloud burst
Heat wave and cold wave
Snow avalanches
Droughts
Sea erosion
Thunder lightning
2. Geologically related disasters
Landslides & mudflows
Earthquakes
Dam failures/ dam bursts
Mine fires
3. Biologically related disasters
Biological disasters & epidemics
Pest attacks
Cattle epidemics
Food poisoning
4. Chemical, industrial & nuclear related disasters
Chemical & industrial disasters
Nuclear disasters
5. Accident related disasters
Forest fires

Urban fires
Mine flooding
Oil spill
Major building collapse
Serial bomb blasts
Festival related disasters
Electrical disasters & fires
Air, road & rail accidents
Boat capsizing
Village fire

Plan preparation process


The entire process of plan preparation has been designated to be carried on at four levels
namely the level 0, level 1, level 2 and level 3. The tasks assigned at these levels are as
following:
Level 0: Developmental phase of monitoring & preparedness.
Level 1: Disasters that can be handled at the district level.
Level 2: Higher intensity disasters that have to be handled at the State Govt. level.
Level 3: Very severe disasters where a major intervention of the Central Government
becomes necessary.
HPC has gone beyond its TOR in recognizing the role of the community as the first
responder and has initiated the process of Panchayat and community level planning.
Plan preparation - culture of quick response
The HPC has proposed the concept of trigger mechanism to initiate a culture of quick
response in disaster management. The trigger mechanism has been conceptualised as an
"emergency quick response mechanism" which, when activated prior to or during a
disaster event simultaneously sets into motion the required prevention and mitigation
measures without any loss of time. Operation of the trigger mechanism would require
clear delineation of duties & functions including identification of key personnel. There
should be adequate delegation from superiors in order to act in the first critical 24-48
hours without loss of time in planning or seeking clearance/approval/direction. Standard
Operating Procedures (SOPs) would require to be evolved in meticulous detail for
effective operation of the trigger mechanism. A Committee headed by DG, civil defense,
is working out the details of laying down of standard operating procedures (SOPs).
HPC- strategies for comprehensive planning
Since the disaster management planning process is an inter-sectoral discipline, the HPC
has evolved certain strategies for comprehensive planning which pervades over a wide
range of tecno-legal and administrative regime.
In purview of the legal framework, a model state disaster management act has been

prepared. Request to enact appropriate legislation has been sent to all chief ministers of
states/UTs and the draft of national calamity management act has also been finalized.
The state govts have been requested to constitute sub-groups on the lines of HPC subgroups to prepare state-specific plans. Theme-specific sub-groups have been constituted
to prepare model state plans.
A Sourcebook on district disaster management plan has been finalized and circulated to
all states/ UTs and districts to facilitate the district level planning process. The model
district plan involving all states & districts is under preparation.
The HPC feels that in order to have an effective disaster management in the field, it is
imperative to involve the NGOs. After 6 consultations involving nearly 400 NGOs held
for four regions of the country and eastern and western Himalayas, a nationwide network
of NGOs was formed named VASUDEVA (voluntary agencies for sustainable universal
development and emergency voluntary action). The national center for disaster
management is the convenor of this network. This network is intended to be an enabling
mechanism to promote cooperation among NGOs without affecting their independence of
action. An action plan for NGOs has also been adopted in the meeting of national core
group of NGOs.
The HPC also felt that training and human resource development is one of the core areas
to be worked upon to facilitate the theme of disaster management. It has proposed for
development of a network of training institutions led by a national level disaster
management institutes with symbiotic linkages with institutions like Indian Institute Of
Technologies (IITs), Indian Institute of Management (IIMs), National Civil Defense
College, National & State Institutes Of Rural Development, ICSSR etc.
The HPC also propose to create a national fund for disaster mitigation with a corpus of
Rs. 500 crore and a district level CRF for ready availability of funds during emergency.

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