Health and education issues in rehabilitation Ms. Neha Madiwala CEHAT

1. Health and education issues in rehabilitation Ms. Neha Madiwala CEHAT

2. Man made disasters Treat disaster affected people as citizens, with human rights, rather than violators of the law.

3. Health impact • Injuries • Hygiene related health problems • Epidemics of infection diseases • Mental health problems • Women’s health issues • Neglect of chronic diseases

4. Immediate Problems • Lack of food, shelter, clothing makes life difficult (especially women’s needs are neglected). People’s capacity to cope is much reduced. They are unable to make decisions and take actions as they do in normal times. • Priority is given to those with serious injuries, ignoring those whose problems are less visible • There is no system of distributing health resources equitably in a disaster situation, wherein the most able are able to get the most • There are several who suffer from the same common minor ailments, who crowd the health camps • People use the health camps as a means of seeking counseling and aid

5. Suggestions • Separate the responsibility of monitoring of the disaster related health functions (emergency care, disposal of bodies, etc)from the relief related health function (public health measures, treatment of the ill, mental health). There should be one person who handles public information related to health situation (and who also pools information received from the field and issues warnings/instructions). • Create a mechanism to pool in govt. and private health resources (personnel, equipment, medicines, appliances) from the very beginning. Create a formal network of govt. and non govt. agencies who are responsible for health. Give them full information about possible outbreaks and precautionary measures. Give them the authority to report on health situations and set up an early warning system. Entrust them with the responsibility of surveillance and reporting of outbreaks.

6. Suggestions - 2 • Initiate preventive health measures as soon as possible - chlorination of water, decontamination of water, pest control,etc. Do not neglect to provide items such as sanitary napkins, which voluntary donors are not likely to provide. • Co-ordinate health camps by developing standard treatment procedures. Make provisions for investigation facilities on site or provide escort, where referrals can be done. • Train volunteers to provide counseling who can go from house to house or do community counseling to look after those who are not in need of medical care. Similarly train volunteers to treat common minor ailments from house to house, so that they do not crowd the camps.

7. Problems - 2 Long term problems • Rehabilitation of the injured and disabled not continued beyond the first phase of relief • Discontinuation of treatment for the chronic diseases after relief efforts begin to peter out • Discontinuation of treatment for those who temporarily migrate • Long term consequences of mental health problems, which have not been addressed • Indebtedness due to health expenditure • Lowered health and nutrition status due to deprivation caused by the disaster • Deaths of young, working age population, causing destitution among certain households

8. Suggestions - 2 • Centralise the aid distribution through a single agency so that all receive aid at one point at one time. Onus on proving eligibility should lie on the state agencies and not on the people. • Make provisions to provide free/subsidised essentials for a longer period of time, rather than giving out large amounts at one go. Provide subsidies and free treatment for a longer period of time beyond the immediate relief effort • Set up a long term health rehabilitation service in the affected areas (at least one year) which has medical, paramedical and voluntary staff within the existing service. • Route aid through existing institutions rather than through ad hoc centres/stations (wherever the infrastructure is not affected) so that is builds trust among the people and also builds expertise in dealing with disaster related problems

9. Impact on Education and Children • Schools take a back seat as there are more immediate survival issues to handle • There are no provisions to provide recreation to children in camps • Children are too traumatised to go back to school • Smaller children are left unattended because families are too busy trying to survive • Older children are too busy gathering small doles from various agencies to go to school • Several children permanently drop-out because of the gap in school-going • Not having books, materials, uniforms, etc. \dissuades children from going back to school

10. Suggestions • Restart schools as soon as possible. Route all direct aid to children (cooked food, study materials, clothes, toys, etc) through the school. Relieve families of the tasks of caring for children. • Train selected teachers in all areas to help deal with post-traumatic stress disorders in children. (A standard curriculum could be devised and offered as a specialty in the teacher-training curriculum or offered as a certificate course through open university). These trained teachers should be specifically entrusted with the responsibility of coordinating the rehab efforts, ,training volunteers and overseeing their work

11. Suggestions • Make relevant changes in the schedule and the curriculum to incorporate elements of community counseling • Make provisions to provide study materials in affected areas (shortages are caused immediately) • Initiate special programmes to re-integrate those who drop-out following a disaster