Pandemic Influenza International Response and Civil-Military Coordination; Exercise Andrew Bates June, 2011 FEMA Higher Education Conference Adapted from Kira Kay - HandswithHands Pan American Health Organization and the World Health Organization Volume #5

International Pandemic Response National/Province/local Response mechanisms National/Province/local Response mechanisms Surveillance Surveillance Containment Containment Response Response Essential services Essential services Regional Response mechanisms Regional Response mechanisms Neighbors & Borders; People and Commerce Neighbors & Borders; People and Commerce Regional assistance organizations; ASEAN, EU, African Union, etc Regional assistance organizations; ASEAN, EU, African Union, etc 2

International Pandemic Response United Nation mechanisms United Nation mechanisms Int’ Health Regulations 2005 Int’ Health Regulations 2005 UN Cluster model UN Cluster model The Big three; WHO, WFP, OCHA The Big three; WHO, WFP, OCHA FAO, UNHCR, UNICEF, IOM, IFRC FAO, UNHCR, UNICEF, IOM, IFRC One Health and Emerging Infectious Diseases One Health and Emerging Infectious Diseases Climate Changes and Population trends Climate Changes and Population trends 3

Civil-Military Coordination When does civil-military coordination become a requirement? When does civil-military coordination become a requirement? Whole-of-Government response Whole-of-Government response Complex Emergencies; The long disaster! Complex Emergencies; The long disaster! NGOs and Do No Harm NGOs and Do No Harm Phased transitions and friction points Phased transitions and friction points 4

5 Planning Task Division Information Sharing CMCOORD slide Information Sharing Task Division Planning Command & Control Relief Recovery Transitions during Civil-Military Responses Foreign Military and Civil Defence Assets International Civilian Relief Local/National Response incl. military Time Need for Assistance

Essential Services Exercise Eight Critical Infrastructure Sectors Eight Critical Infrastructure Sectors Food/Agriculture Food/Agriculture Water/Sanitation Water/Sanitation Transportation Transportation Telecommunications Telecommunications Rule of Law & Defense Rule of Law & Defense Healthcare/Public Health Healthcare/Public Health Banking/Credit Banking/Credit Power/Electricity Power/Electricity 6

7 Learning objectives Learning objectives You will be able to: Define what is meant by mass graves Define what is meant by mass graves Explain the role of the community and military in mass graves situations Explain the role of the community and military in mass graves situations Define the legal, social, and psychological impacts Define the legal, social, and psychological impacts Determine planning initiatives Determine planning initiatives Mortuary Affairs

8 Disaster Response Priorities Authorities must look for and care for the living first Authorities must look for and care for the living first Secondly; the authorities must restore essential services to support the living; Power, Water, Food, transportation, telecommunications, and shelter Secondly; the authorities must restore essential services to support the living; Power, Water, Food, transportation, telecommunications, and shelter Authorities must work to identify and process the dead Authorities must work to identify and process the dead Mortuary Affairs

9 Characteristics in Mass Casualty Situations What happens? Relatives and friends are looking for the dead Relatives and friends are looking for the dead Authorities are searching for victims who are alive Authorities are searching for victims who are alive Mortuaries are overwhelmed Mortuaries are overwhelmed Police and medical personnel must provide information to maintain order Police and medical personnel must provide information to maintain order Mortuary Affairs

10 Preparing for Mass Death Identify coordinating institutions in advance – mortuaries, religious groups, hospitals, police & military and others as appropriate Identify coordinating institutions in advance – mortuaries, religious groups, hospitals, police & military and others as appropriate Provide technical training for body identification Provide technical training for body identification Develop relations with the Media per roles and responsibilities Develop relations with the Media per roles and responsibilities Mortuary Affairs

11 Public Perceptions and Community Relations Public Perceptions and Community Relations What are some ways to assist? Any identifying items must be saved; photos, cards, Any identifying items must be saved; photos, cards, and documents: They must be logged with the location of where the body was found and documents: They must be logged with the location of where the body was found Get the local religious leader to declare a special situation in order to expedite graves: Hindu, Buddhist, Moslem, Christian Get the local religious leader to declare a special situation in order to expedite graves: Hindu, Buddhist, Moslem, ChristianWhy? Emotional response of friends and family Emotional response of friends and family Impact of media difficult to quantify Impact of media difficult to quantify Increase in political complexity = increase in controversy Increase in political complexity = increase in controversy Civilians can hinder rescue operations and logistics Civilians can hinder rescue operations and logistics Mortuary Affairs

12 Planning Operational Public Health Items Planning Operational Public Health Items Organized shifts and reserves Organized shifts and reserves Prepare the workers to deal with mass casualties Prepare the workers to deal with mass casualties Get supplies stored and pre-positioned; Body bags Get supplies stored and pre-positioned; Body bags Can alternative sites be acquired to avoid mass grave situations. Consider refrigeration if possible Can alternative sites be acquired to avoid mass grave situations. Consider refrigeration if possible Only preserve bodies that are not identified Only preserve bodies that are not identified Request ICRC assistance to provide guidance on mass graves. Request ICRC assistance to provide guidance on mass graves. Mortuary Affairs

13 Cultural Considerations Get local religious leaders engaged in the communications process Get local religious leaders engaged in the communications process If the cultural norm is cremations do it quickly and away from the population centers If the cultural norm is cremations do it quickly and away from the population centers Allow for limited mourning and rituals Allow for limited mourning and rituals Determine the level of family authorization Determine the level of family authorization Mortuary Affairs

14 Psychological Aspects Shock and Trauma for victims Shock and Trauma for victims Post Traumatic Stress Syndrome Post Traumatic Stress Syndrome Notification process Notification process Counseling services Counseling services Importance of truth and a structured process for accounting of the dead Importance of truth and a structured process for accounting of the dead Mortuary Affairs

15 Religious and cultural considerations Involve community leaders and educate them with ICRC standards which provide proper mass grave markings Involve community leaders and educate them with ICRC standards which provide proper mass grave markings Group religious types in the same grave or storage areas if possible Group religious types in the same grave or storage areas if possible Do not physically disrespect a dead body if possible Do not physically disrespect a dead body if possible Mortuary Affairs

16 Legal Considerations Legal implications of unidentified bodies Legal implications of unidentified bodies Missing persons Missing persons National and International legal issues National and International legal issues Mass Graves markings; ICRC International standards Mass Graves markings; ICRC International standards Return of foreign nationals to their homeland during a pandemic Return of foreign nationals to their homeland during a pandemic Mortuary Affairs

17 Summary Treat bodies with respect Treat bodies with respect Provide training and exercises for burial tasks that are part of the disaster plan Provide training and exercises for burial tasks that are part of the disaster plan Work through the local authorities Work through the local authorities Involve religious people when you can Involve religious people when you can Identify and record body remains and personal effects Identify and record body remains and personal effects Involve the media if possible in exercises Involve the media if possible in exercises Mass grave sites must be planned for in advance Mass grave sites must be planned for in advance Take care of your people Take care of your people Mortuary Affairs

18 QUESTIONS?