What is Early Rehabilitation in Disasters and Conflicts

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Rucha Gadgil, Lucinda hampton, Jess Bell, Rishika Babburu and Tarina van der Stockt      

Introduction

Rehabilitation: Young woman

Rehabilitation is a concept that is widely discussed globally. This is by no means unexpected since over a billion people now live with some form of disability, accounting for over 15% of the world population. Furthermore, 2.41 billion individuals worldwide live with the conditions that impact their functions in daily life and would benefit from rehabilitation services, which equates to 1 in 3 individuals requiring rehabilitation services throughout the course of their illness or injury. Fundamentally, rehabilitation is founded on the philosophy that every individual has the inherent tendency and right to be an expert in their own health care,and is one of the core health strategies of the World Health Organisation, who define rehabilitation as "a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.”

Impact of Context

Beirut Explosion

One of the most important factors in rehabilitation is the impact of contextual factors, including the overall context in which rehabilitation takes place. We know that the environment is known to have a significant impact on treatment generally, therefore, the circumstances surrounding rehabilitation, from the situation before, during and after the event leading to a loss in function are all important factors to consider throughout the rehabilitation process. The context in which rehabilitation occurs also greatly greatly influences the range and availability of rehabilitation services and their utilisation.

Despite disasters and conflicts being challenging contexts, rehabilitation has been integrated into the emergency responses within these contexts since the first world war, albeit traditionally only considered at the later stages of response. Due to advances in response, management and post medical care in disaster situations, high mortality rates have gradually transitioned to increased morbidity rates and as a result in more recent disasters, such as the 2015 Nepal earthquake and the 2020 explosion in Beirut, Lebanon, there has been a definite shift in this with the concept of ‘early rehabilitation’ positioning itself firmly within the initial emergency response phase. In humanitarian emergency situations such as during or post-conflict and disaster situations, the need for basic functional rehabilitation services is overwhelming and critical to preventing disability and improving the lives of people with disabilities.

Defining Early Rehabilitation

Medical Emergency Response Team

The concept of early rehabilitation is not new but was initially developed within acute hospital settings in response to an increasing number of patients surviving serious disease and injury, and has is now considered standard of care within these contexts due to reduced hospital stays, reduced overall costs and improved health outcomes with a reduced probability of long term disability.

While there have been some challenges in defining exactly what early rehabilitation is and when it should begin within disaster and conflict settings, early rehabilitation is now recognised as being an integral part of a patient’s recovery in conflicts and disaster situations. Now considered to start around the time of initial injury and around the onset of acute care, early rehabilitation has been shown to help prevent or reduce complications, speed recovery, optimise the potential for long-term functional recovery and quality of life, reduce the length of stay at the hospital level, ensure links to ongoing services and continuity of care.

Early rehabilitation may include the provision of mobility devices, acute burn care and splinting, peri-operative fracture and amputation care, the prevention of complications of spinal and nerve injuries, early mobilisation and respiratory care, patient and caregiver education, pain management and early supported discharge planning or coordination. Accordingly rehabilitation professionals need skills across a wide range of clinical areas, and need to be able to manage challenges including large surges in patient numbers, limited equipment, and complex clinical presentations in disaster and conflict settings. Other areas to consider, particularly for vulnerable populations such including children, older persons and people with a disability include;

• Collaboration and Governance
• Capacity Building
• Person-Centred Multidisciplinary Care
• Improved Communication
• Active Participation of Disaster and Conflict Survivors / Family / Community Partners
• Strengthen Evidence-based Information, Education and Access to Information
• Support Education and Strengthen Community-based Rehabilitation Service

Challenges

In disaster and conflict settings local health systems are generally overwhelmed damaged or destroyed, and may often be understaffed as a result of healthcare staff themselves being injured or killed, resulting in sub-optimal or adjusted medical or surgical management of injuries, with limited access to services, such as imaging or specialist surgery or medical supplies including rehabilitation equipment. Other challenges impacting patient treatment and safe discharge include damaged or destroyed records systems, patients' homes damaged, destroyed or inaccessible and ongoing risks either from enduring hazards or continued armed conflict all on a background of psychological trauma.

Guidelines

Rehabilitation professionals face unique challenges associated with complex trauma, injury surge and resource scarcity that many have never encountered before. Practical guidance to deliver quality early rehabilitation in these contexts is essential if conflict and disaster response is to evolve beyond its life-and limb-saving mandate to deliver care that maximises patient outcomes. Rehabilitation professionals need to be equipped with the knowledge and skills to meet patient needs and navigate the demands of emergency medical response.

Early rehabilitation is now grounded in international guidelines, including The Sphere Handbook: Universal Minimum Standards for the Delivery of Quality Humanitarian Response and The World Health Organization emergency medical team standards and recommendations for rehabilitation, launched in 2016, also signal significant progress in recognising the role that rehabilitation professionals play and the necessity for early rehabilitation, which remains an emerging but growing area. While Article 11 of the United Nations (UN) convention on the rights of persons with disabilities mandates that rehabilitation interventions should occur during early disaster response.

Summary

In disaster and conflict settings, early rehabilitation is an essential component of clinical care and healthcare provision from the onset of the event and essential to mitigating the considerable legacy of disability that follows a surge in traumatic injuries and exacerbation of chronic medical conditions with devastating consequences for individuals, families and communities are a result of insufficient access to early rehabilitation.

Resources

Guidelines

• Classification And Minimum Standards For Emergency Medical Teams
• Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation
• The Sphere Handbook: Universal Minimum Standards for the Delivery of Quality Humanitarian Response

Early Rehabilitation in Conflict and Disasters

• Early Rehabilitation in Conflict and Disasters Field Handbook, Humanity and Inclusion (HI)
• Early Rehabilitation in Conflict and Disasters Online Training
• Early Rehabilitation in Conflict and Disasters YouTube

Rehabilitation in Sudden Onset Disasters

• Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion (HI)
• Responding Internationally to Disasters: A Do’s and Don't Guide for Rehabilitation Professionals
• The Role of Physical Therapists in Disaster Management, World Physiotherapy