Role of Rehabilitation Professionals in Early Rehabilitation in Disasters and Conflicts
Original Editors - Naomi O'Reilly
Introduction[edit | edit source]
What exactly is the role of rehabilitation professionals within early rehabilitation in disasters and conflicts and where do they fit in with the disaster management continuum? The International Federation of Red Cross & Red Crescent Societies defines disaster management, as the organisation and management of resources and responsibilities for dealing with all the humanitarian aspects of emergencies, in order to lessen the impact of disasters . It provides a continuum of four phases: preparedness, response, recovery and mitigation, although in practice each of the four phases often blends into the next, with no clear beginning or end as can be seen in the Figure.1. For the purposes of early rehabilitation, we will focus on the role of rehabilitation professionals within disaster preparedness and response, which is where early rehabilitation fits within the continuum.
Disaster Preparedness[edit | edit source]
"The knowledge and capacities developed by governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current hazard events or conditions" . .
According to ICRC, Disaster Preparedness refers to measures taken to prepare for and reduce the effects of disasters, be they natural or man-made. This is achieved through research and planning in order to try to predict areas or regions that may be at risk of disaster and where possible prevent these from occurring and/or reduce the impact of those disasters on the vulnerable populations that may be affected so they can effectively cope. Disaster preparedness activities embedded with risk reduction measures can prevent disaster situations and also result in saving maximum lives and livelihoods during any disaster situation, enabling the affected population to get back to normalcy within a short time period .
Minimisation of loss of life and damage to property through facilitation of effective disaster response and rehabilitation services when required. Preparedness is the main way of reducing the impact of disasters. Community-based preparedness and management should be a high priority in physical therapy practice management .
Rehabilitation professionals can make significant contributions to disaster management preparedness by being aware of any specific hazards and the vulnerability of their country/region, and the likely consequences of disasters that could occur. This should include consideration of likely specific disease or injury types, as well as response capacity and possible impact on existing healthcare services. Early rehabilitation should then be incorporated into the healthcare disaster management plan, ensuring an integrated response with clear roles for rehabilitation professionals from the outset and definitive referral pathways for patients. 
Preparedness planning should take place on the level of the individual (personal), their place of work (organisational) and their locality (both regional and national). Mapping of human and institutional resources from across the rehabilitation sector is critical and aids a coordinated disaster response; it informs training needs and the prepositioning of equipment. One way to consider preparedness for early rehabilitation in emergencies incorporating each level is to consider it in terms of four domains: Staff, Stuff, Systems and Space:
Disaster Response[edit | edit source]
"The provision of emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs of the people affected" .
Focused predominantly on immediate and short-term needs, the division between this response phase and the subsequent recovery phase is not clear-cut and can last from a few days to several months, and much longer in many conflicts. Some response actions, such as the supply of temporary housing and water supplies, may extend well into the recovery stage. Rescue from immediate danger and stabilisation of the physical and emotional condition of survivors is the primary aims of disaster response/relief, which go hand in hand with the recovery of the dead and the restoration of essential services such as water and power .
Leadership and Coordination Actors[edit | edit source]
The first people to respond to disasters and conflicts are those affected by them, with local, national or international support arriving over the first days and weeks. While primary responsibility for coordinating national health sector disaster response lies with the affected government, coordinated multi-agency responses are also a vital support at this stage of Disaster Management in order to reduce the impact of a disaster and its long-term results with relief activities including 
- Provision Food and Water
- Provision Emergency Health Care
- Prevention of Disease and Disability
- Repairing Vital Services e.g. Telecommunications, Transport
- Provision Temporary Shelter
In severe humanitarian situations, or where existing national response or coordination capacity is unable to meet needs in a manner that respects humanitarian principles such as armed conflict then an Inter Agency Standing Committee (IASC) Cluster Approach may be implemented. These clusters are groups of humanitarian organisations, both UN and non-UN, in each of the main sectors of humanitarian action, e.g. water, health and logistics with the World Health Organisation as the lead agency for the Health Cluster, and when activated, allow organisations to coordinate and pool information, such as shared needs assessments, gaps and priorities. (Figure 2.)
Early Rehabilitation Actors[edit | edit source]
The variety and quantity of rehabilitation actors involved in emergency response will vary hugely depending on the scale and severity of the disaster, pre-existing level of health/rehabilitation infrastructure and the ability of local and regional actors to cope in both the immediate and longer-term. The initial stages of large-scale emergency response can often be chaotic, especially if there are no clear preparedness plans in place and infrastructure has been damaged. In areas of chronic instability and conflict, this disorder can persist. Table 2 looks at some of the common actors, not including emergency medical teams that refer to groups of health professionals and supporting staff that aim to provide direct clinical care to populations affected by disaster or outbreaks and emergencies by acting as surge capacity to support the local health system, which you can find more detailed information on elsewhere. 
|National Organisations||International Organisations|
Where available it is the National Rehabilitation Staff that provide the bulk of early rehabilitation, with deployment of appropriate international rehabilitation sector assistance only if it is required and requested from the host country. In-country rehabilitation responders may include:
The International Committee of the Red Cross (ICRC) and The International Federation of Red Cross and Red Crescent Societies (IFRC) often have roles to play in rehabilitation.
Other International Non-Governmental Organisations (INGOs) may either at the request of the host country, or in response to significant humanitarian needs respond to provide assistance in many sectors, such as water, sanitation, hygiene, education, health, shelter etc. The following INGOs are examples of those that have recently supported rehabilitation responses in emergencies:
NOTE: It is essential that the individuals responding understand their own role and that of the wider humanitarian response, in particular the Humanitarian Principles.
Role of Rehabilitation Professionals in Response[edit | edit source]
The role of rehabilitation professionals in this phase will be dependent on the nature and scale of the emergency, the experience and training of individuals, as well as local health and rehabilitation infrastructure.
Best Practice Example; Physical and occupational therapists were involved in the response to the Nepalese Earthquake of 2015 from the initial few hours as a result of rehabilitation being appropriately embedded into trauma emergency plans.
According to the field handbook for Early Rehabilitation Conflicts and Disasters  the responsibilities of rehabilitation Professionals in the initial response may include:
- Early rehabilitation for those with injuries or illness
- Assess, advise, fit and provide assistive devices, with training on use and maintenance
- Rapidly discharge of existing stable patients to free up bed space for incoming acute patients
- Provide guidance and education to patients, carers and other healthcare professionals
- Coordinate discharge, onward referrals and follow-up of patients once they leave healthcare facilities
- Assess environments and environmental adaptations needed to ensure accessibility
Additional responsibilities are both context, skill and training specific to the rehabilitation professional and might include:
- Conducting rehabilitation needs assessments including mapping of available resources and gaps and coordinating an integrated rehabilitation response at either local or national level
- Triage of Patients
- Providing basic psychosocial support / psychological first aid, or onward referral to appropriate services
- Identify and assess people with specific vulnerabilities (such as age, gender or disability) who may find it harder to access services or receive support
- Rapid on-the-job training of rehabilitation colleagues in more specialised areas (such as spinal cord injuries)
- Rapid training of community workers, or other professionals or organisations, to identify those in need of rehabilitation services
- In the absence of rehabilitation assistants, train healthcare workers to support rehabilitation services
- Advocate for quality rehabilitation provision and basic needs for those injured, at an organisation, local and national levels, including use of injury-specific data to monitor outcomes effectively.
- Ensure inclusion of injured and vulnerable people in the emergency response and recovery phases (specifically considering long-term service provision, education, livelihood, shelter and accessibility
Resources[edit | edit source]
Disaster Management Guidelines[edit | edit source]
When disasters strike, there is always a huge amount of goodwill from rehabilitation professionals around the world who wish to use their skills to support those affected. This brief guidance informs those who are considering responding internationally to a disaster either as individuals or as part of a team. It highlights key questions to consider before departing, whilst working in the disaster area and on returning home. Responses to these questions considered are presented as “Do’s and Dont's” which are exemplified by recommended practices and those to avoid in the real case studies below. The guidance note is not intended to be a step-by-step or technical guide, nor is it exhaustive, and does not supersede any specific guidance provided by your own global professional body.
A Guidance Document in simple language for health personnel, setting out their rights and responsibilities in conflict and other situations of violence. It explains how responsibilities and rights for health personnel can be derived from international humanitarian law, human rights law and medical ethics. The document gives practical guidance on The Protection of Health Personnel, the Sick and the Wounded, Standards of Practice, The Health Needs of Particularly Vulnerable People, Health records and transmission of medical records, "Imported" Health Care (including Military Health Care), Data Gathering and Health Personnel as witnesses to violations of International Law and Working with the Media
|Early Rehabilitation in Conflicts and Disasters
Humanity and Inclusion in collaboration with leading organisations (ICRC, MSF-France, CBM, Livability & the WHO) have created the world’s first educational resource package to address early rehabilitation in conflicts and disasters. The educational resource package covers 6 clinical areas:
The role of rehabilitation professionals in responding to sudden-onset disasters, such as earthquakes or tsunamis, is evolving rapidly and they increasingly find themselves at the forefront of emergency response teams. This manual is designed for Physiotherapists and Occupational Therapists who provide rehabilitation in the immediate aftermath of a sudden onset disaster. It was developed to support volunteers on the UK International Emergency Trauma Register but with the aim of being relevant to all rehabilitation professionals interested in rapid deployment to austere environments.
The purpose of this document is to extend these standards for physical rehabilitation and provide guidance to Emergency Medical Teams (EMTs) on building or strengthening their capacity for and work in rehabilitation within defined coordination mechanisms. The standards and recommendations given in this document will ensure that EMTs, both national and international, will better prevent patient complications and ensuing impairment and ensure a continuum of care beyond their departure from the affected area.
This manual is intended to help health professionals and public health coordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations.
The consensus-based Field Guide, Management of Limb Injuries during disasters and conflicts and the complementary open-access online resources gathered here are aimed at providing that guidance. It draws on the expertise of the International Committee of the Red Cross, which has a long history of delivering care to patients and protecting them in conflict. This field guide will be regularly updated as new controversies are raised and evidence grows.
References[edit | edit source]
- International Federation of Red Cross and Red Crescent Societies. About Disaster Management. http://www.ifrc.org/en/what-we-do/disaster-management/about-disaster-management/ [Accessed: 03 Jan 2017]
- Ben Lockspeiser. Four Phases of Emergency Management. Available from: https://youtu.be/tKa8POjWfE0[last accessed 30/10/17]
- WCPT. What is disaster management? http://www.wcpt.org/disaster-management/what-is-disaster-management. [Accessed: 5 Jan 2017]
- Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters. Handicap International: London, UK. 2020.
- WCPT. The Humanitarian Response. Available from: https://youtu.be/EgIVz6VrRV4[last accessed 26/02/2022]