RDR IN IRAN

1. RDR IN IRAN DR.Farzaneh Torkan.MD Chair of physical and rehabilitation medicine department of Shefa research center.

2. Introduction Natural disasters such as earthquakes, volcanic eruptions, floods and destructive winds threaten human health and leave many disable survivors every year, which were once active society members. The situation is much more critical for handicaps and disabled people, because of disability to manage the very acute phase of disaster, and their disabilities might even intensify.

3. “Complex” Disasters Man made Disasters Natural Disasters

4. IRAN is one of the more prevalent country of natural disasters.

5. Disasters recorded in IRAN 1900-2016

6. Earthquakes in IRAN 1900-2016

7. IRANBam Earthquake survivors • A 5.6 Richter earthquake occurred in 26 December 2004 in Bam. • Based on reports, more than 40000 people died and 85000 became homeless. • All the city was ruined; social and economic services were lost completely. Brick Building of Bam which was a historical and touristic building was ruined. 60% of the Bam city and 80% of rural sites were destroyed. • 120000 people were injured by the earthquake directly. • Half of governmental staff were died. • People, government and all the world helped the victims. Borders were open to all world support organizations. • 75 rescue teams from all over the world were there to help.

8. CLINICAL NOTE Earthquakes and Rehabilitation Needs: Experiences From Bam, Iran Abstract Background: In December 2003, a devastating earthquake destroyed Bam and surrounding areas in Iran, leaving many people with residual deficits and disabilities, of which approximately 240 patients had spinal cord injury (SCI). Methods: As an independent volunteer working in outpatient clinics, I visited the patients as part of a mobile team and set up a short educational course in spinal cord medicine. Results: I visited 34 patients with SCI in the first 3 months. Eight months after the disaster, I visited 54 patients with SCI, 29 female (53.7%) and 25 male (46.3%). Postdisaster problems were identified, including need for accurate data collection, identification of patients’ conditions, attention paid to psychosocial issues, ethical dilemmas, and research needs. Conclusion: Disaster preparedness for earthquakes should include first aid and injury prevention, coordination of relief efforts, basic education and medical care, and short-and long-term rehabilitation needs. The major focus of rehabilitation medicine specialists’ should be education of the general and professional population toward integrating the concept of rehabilitation. J Spinal Cord Med. 2007;30:369–372 Gholam Reza Raissi, MD Physical Medicine & Rehabilitation Department, Iran University of Medical Sciences, Tehran, Iran Received August 19, 2005; accepted November 13, 2006

9. FINDING One of the most important problems, especially in the first months after the disaster, was lack of sufficient data. There was a lack of organized effort for gathering data by governmental organizations and a lack of coordination with the separate efforts of nongovernmental organizations (NGOs). in the first months after the disaster, patient identification and data collection were hindered by the dispersion of the people of Bam to other areas of the country, lack of expert personnel, loss of preexisting data during the earthquake, frequent relocation of the people, and loss of addresses and maps due to destruction of the city. Many local physicians and managers also died, and nearly all of those who remained had problems with loss of family, friends, and property. Some NGOs without any previous experience were working with disabled patients. In general, NGOs lack information and resources that are not specific to their mission and may lack a holistic approach. The Journal of Spinal Cord Medicine Volume 30 Number 4 2007

10. Transportation was another major problem, particularly for individuals with SCI needing access to rehabilitation services. Although a few mobile teams consisting of a physiotherapist and sometimes an occupational therapist were partly effective, the medical and nursing problems of these patients remained largely untreated. The success of individual rehabilitation depends heavily on how well the person reintegrates into society. Reintegration is dependent partly on the adequacy of the physical rehabilitation and partly on the patients and their support system Rehabilitation can only be effective if properly combined with social, cultural, religious, and economic considerations. Educating local personnel to provide rehabilitation services would result in better, faster care at lower costs and for longer terms. Because rehabilitation is deeply related to the patient’s everyday life and culture, even local personnel are much more effective than the staff recruited from other parts of the country. The Journal of Spinal Cord Medicine Volume 30 Number 4 2007

11. FINDING Even in a disaster situation, research is needed for proper decision making and to gain experience for future aid . Results of disaster research provide informed advice about the probable health effects of future disasters, establish priorities for action by emergency medical services, and emphasize the need for accurate information as the basis for relief management decisions Lack of time, personnel, and equipment, on the other hand, makes research during a disaster difficult to conduct. The first hours after the disaster are the most important time for rescue of the casualties and outside medical assistance usually arrives too late for immediate care, that is, after local health services have already provided emergency medical assistance . Some studies suggest that initial emergency medical needs are best met by local providers

12. WHATE WE LEARNED? Each disaster is an opportunity to learn how to face future inevitable disasters . It also magnifies the health problems of the community that may not have been considered seriously under usual conditions. The general population, especially in high-risk regions, must be trained in first aid, including the proper techniques for extricating and handling patients for prevention of further disabilities (eg, SCI). Organizations that have direct responsibility in such conditions must also train their personnel in the measures of disability prevention and managing disabled persons.

13. IRANRoodbar Earthquake survivors 1- Injuries in female were significantly more frequent than male. This earthquake was happened at night and all the family members were in the home. It seems that women are more vulnerable to earthquake injuries because of lower awareness, readiness, physical power; so we have to pay special attention toward this group. 2-More than half of all injuries occurred at lumbar spine causing spinal cord injury; so rescuers and rehabilitation team should be equipped with lumbar hard corsets. , by Dr Kamali et al

14. IRANRoodbar Earthquake survivors 3-In more than 95% of victims, first aid medical services were offered at site. However, rehabilitation services were delayed for nearly 6 months and in some cases several years. 4- The most important need of the injured after the event were rehabilitative and supportive services. From 64 injured people, 21 needed rehabilitation and 39 needed rehabilitation and supportive services. by Dr Kamali et al

17. Ensuring access to rehabilitation in emergency: the IRCS approach NATIONAL IRANIAN PROTCOL • S.MasoudMarashiyan Head of General Rehabilitation Center of IRCS

18. Introduction Loss of information and public awareness lead to less acceptance of these people in society and have adverse effect on facilitating their presence in community as active members. Therefore, it is necessary to improve public awareness and provide for information before disaster. That would make it possible to prevent more disabilities. These series of constant, coordinated, scheduled activities of professional medical, social and rehabilitating services, before, during and after crisis with the objective of prevention, treatment ,and health and functional enhancement are called‘emergency rehabilitation after natural disasters'.

19. DISASTER Disaster management Disaster management Preparedness response rehabilitation mitigation prevention reconstruction Development Disaster management program

20. Prevention , Mitigation Preparedness • Pre disaster • Post disasterRecovery During disaster Emergency phase Health care facilities (search & rescue , first aid, …) Relief phase , psychotherapy, … Response Rehabilitation Rehabilitation

22. Target groups include: • those that were disabled or used assistive devices (even eye glasses or hearing aid) before the disaster . • peoples that are in risk of developing disability due to the disaster and are in need of immediate medical rehabilitation services. To this end, provision of a protocol and organizing emergency rehabilitation teams in Iranian Red Crescent Society (IRCS) became a priority and were put on agenda.

23. protocol This protocol is divided into two sections: 1/ Presents principles of preventing disability aggravation and appropriate strategies to face disasters for handicaps (before, during and after the disaster), which includes preparedness, awareness, organizing emergency rehabilitation teams, supplying emergency response unit (ERU) and evaluation process.

24. Disaster management • Pre: • Public education • Identifying community facilities • Cooperation with relevant organizations • Primary anticipation of damage and planning for injured people’s needs • Identifying appropriate strategies for supporting activities in damaged areas • Identifying and prospecting places and shelters to transfer injured and handicapped people • Gathering statistics about handicaps and their full profile for in time identification and transfer from disaster site

25. Protocol 1 Principles of preparedness for natural disasters and accidents • Organizing and training professional rehabilitation aid teams • Describing general tasks of the teams • Principles of aiding disabled people in disasters • Cooperating and exchanging information to improve services’ quality • Injury prevention and methods of aiding injured people (spinal cord injuries) A: increasing general awareness for self-care B: training caregivers about managing the injured • Modes of aiding disabled people prior to disaster 1. people with ambulatory disabilities 2. people with speech disability 3. people with hearing difficulties 4. people with visual disorders

26. Protocol 2/ management and provision of rehabilitation services necessary for injured people after disaster.

27. Post accident practical responses • ACUTE PHASE 2) RECONSTRUCTION

29. Disaster management • Post: • Rapid and primary evaluation of damage and injured people • Identification and evaluating people with amputation and disability due to disaster • Adopting appropriate and proper methods of transferring people to safe places • Primary survey of handicaps’ situation in area • Providing services required by injured people and handicaps

30. DISASER MEDICAL REH.TEAM (DMRT) To ensure the optimal rehabilitation services, the establishment of a professional rehabilitation team is essential, the members of which will in fact be primary body of operational committee. The team is called Disaster Medical Rehabilitation Team (DMRT) and their main responsibility would be professional evaluation and recognition of injured peoples' needs.

32. Ensuring access to rehabilitation in emergency for PWD

33. Global situation • Around 150 million adults experience significant difficulties functioning • Disability prevalence is increasing • Disproportionately affects vulnerable populations: women, older people and poor households

34. People with disabilities face barriers in all areas of life • Education • Employment • Social & political life • Community participation • Health • disasters

35. United Nations High Level Meeting on DisabilityGeneral Assembly, 23 September 2013 • First ever UN General Assembly high-level meeting on disability • Commitment to global disability inclusive development agendas • Urgent action to improve health care, rehabilitation, and strengthen data

36. Aims of rehabilitation in unexpected disasters Reduced society vulnerability Gaining required preparations and ability to react in case of events. Regaining of personal and social health of pre-event Expanding long term preparedness towards unexpected disasters after the event

37. Principles of rehabilitation activities 1- Primary rehabilitation should be accompanied by rescue activities. 2- Rehabilitation activities should be rapid, in time, effective, fair, equal and clear. 3- Rehabilitation acts should be comprehensive, inclusive and satisfactory. 4- special attention to high risk groups including children, elderly, women and disabled.

39. Principles of rehabilitation activities 5- Complete attraction of societies and specialized scientific organizations and charity bodies and appropriate management. 6- Complete and effective coordination of all rehabilitation activities in a team format and division of labor and supervision. 7- Act quickly with complete necessary accuracy in all phases. 8- Utilization of complete media capacity.

40. THANKS