By Alisa Tang
BANGKOK (Thomson Reuters Foundation) - When natural disasters strike, most public health risks come from sectors such as housing and construction, says Iranian health and disaster expert Ali Ardalan.
A shoddy building collapses in an earthquake, people are injured, then hospitals and health professionals respond.
So Ardalan has worked to strengthen Iran's healthcare system - from hospitals to the country's 150,000 female community health volunteers - by training them in what to do when disasters strike.
"Disasters have an impact on public health, and health systems have to take a proactive approach, preventive measures to reduce the risk of disasters," said Ardalan, chair of the Disaster and Emergency Health Academy at Tehran University of Medical Sciences.
Ardalan was one of several speakers at a conference held last week in Bangkok to discuss implementation of health aspects of the Sendai Framework for Disaster Risk Reduction adopted by U.N. member states a year ago.
Health is a relatively new aspect of disaster risk reduction. The Sendai accord was the first to give health a higher profile, with measures to protect health by reducing damage to hospitals and ensuring medical care continues in disasters. It also tackles the risks of epidemics and pandemics.
In the decade ending in 2014, disasters caused $1.4 trillion in damage, killed about 700,000 people and affected 1.7 billion others, according to the U.N. Office for Disaster Risk Reduction.
INFRASTRUCTURE, HOSPITALS OFTEN WIPED OUT
Key infrastructure and healthcare facilities are often wiped out.
The 2008 Sichuan earthquake in China damaged or destroyed 11,000 hospitals, while the 2004 Indian Ocean tsunami damaged 61 percent of health facilities in Aceh, Indonesia, killed 7 percent of the area's health workers and 30 percent of its midwives, according to the Overseas Development Institute.
Disaster health experts like Ardalan have focused on building resilience and preparing for such catastrophes.
Iran has worked to ensure its hospitals have disaster contingency plans, including evacuation plans in the event of an earthquake or flood, said Ardalan, who is also a visiting scientist at the Harvard School of Public Health and an adviser to the World Health Organization.
Iran has also trained its community health volunteers - all women - to conduct household training, which includes drawing a household earthquake risk map to show danger spots near big windows or under large ceiling lights, as well as safe spots under tables or near pillars.
Last year, the volunteers trained 500,000 households across Iran, he said.
"We believe it's better to be proactive, work with them, so they are sensitive to their safety and know how to react if something happens," he said on the sidelines of the conference.
"It's a very-cost effective intervention for the entire society."
REMOTE COMMUNITIES IN CHINA
Similar efforts are under way to provide health and disaster preparedness for ethnic minority communities in rural China.
Emily Ying Yang Chan, who worked for Médecins Sans Frontières for 17 years and now heads the disaster and medical humanitarian response center at Chinese University in Hong Kong (CUHK), began the ethnic minority health program about six months after the Sichuan quake.
The typical community her team works with is two flights and a seven-hour bumpy car ride away, though one village, 5,000 meters above sea level on the Tibetan Plateau, took 17 hours to get to in a four-wheel-drive car.
Chan's approach has been to provide the knowledge or help that villagers request, on condition that her team gets to conduct disaster risk training.
Most communities want to learn more about economic development, though women also ask them to teach their husbands not to smoke or how to read food labels.
In return, Chan and her students from the Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC) give health advice such as not burning waste indoors and reducing salt intake.
Then the team helps the community to prepare disaster kits, handing out red cloth bags, with large Chinese characters that read "rescue bag".
They put in soap, a towel, a bottle of water and non-perishable food, as well as a manual battery-less torch and a multipurpose knife with a can opener - which Chan said has often been missing from aid packages.
"A lot of agencies sent food supplies, but forgot to send a can opener, and many people come to the clinic with cuts because they use whatever they can to cut (open the can)," she said.
The ethnic minority health program team has worked in 11 villages, visiting each one four times over a two-year period.
The biggest challenge now, Chan says, is digesting the data they have gathered, to improve and scale up assistance for the villagers.
Disaster and Emergency Health Academy - http://nihr.tums.ac.ir/disaster/
conference in Bangkok - http://www.unisdr.org/conferences/2016/health
UNISDR statistics - https://www.unisdr.org/we/inform/disaster-statistics
Overseas Development Institute - http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9472.pdf
CCOUC - http://ccouc.org/home
(Reporting by Alisa Tang, editing by Tim Pearce. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, corruption and climate change. Visit http://news.trust.org to see more stories)