To improve the response to future disasters, the world needs a network of experts and clear procedures to deal with psychological trauma and mass fatalities. At times of disaster, uncoordinated needs assessments are counterproductive. Insufficient support is given to women?s health. Clear roles, responsibilities and procedures need to be worked out so that military and civilian organizations can work together on disaster responses.

As the health arm of the United Nations, the World Health Organization (WHO) is asked to play a stronger role in disasters ? directing volunteer doctors and nurses, distributing donated equipment and medicines and monitoring the health of affected communities.

These were some findings and recommendations that 400 health practitioners from more than 130 countries, organizations and the military made after a three-day conference looking at lessons learned and ways to improve the health response to natural disasters. Recommendations will be taken to the World Health Assembly in Geneva. Dr David Nabarro, special representative of the WHO director-general said: ?The tsunami has shown that countries can prevent disease outbreaks but the world must be prepared to deal more effectively with psychological trauma, health needs of women and mass fatalities. By applying what we have learned, we can be better prepared. More lives will be saved and affected communities will recover more rapidly.?

Unify needs assessments and stop duplication. After the tsunami, some communities were overwhelmed by multiple assessment teams giving them the same health checks day after day. Eventually they refused to co-operate and this hampered relief distribution.

Clarify procedures for military and civilian agencies. In the tsunami response, national militaries took a leading role in the first few weeks of the emergency. In addition, over 30 militaries from around the world provided logistical and communications assistance. WHO is called upon to take the lead on procedures for health assessments and response.

Agree on simplified procedures to deal with psychological trauma and mental ill health. WHO estimates that around 80% of psychosocial needs were addressed in the community. Outside experts were needed for essential help. Better guidance is needed to improve the treatment of those suffering from psychological trauma and other forms of mental illness.

Set up a pool of forensic pathologists for dead bodies. Experts should work to agreed standards and be made available for large-scale emergencies. In Thailand alone, the government found itself coordinating forensic experts from around 30 countries using different standards for victim identification ? ranging from Polaroid photos to DNA testing. WHO has now been asked to take a lead on harmonizing techniques and identifying experts to provide this assistance.

Focus on health threats faced by women. In disasters, women are particularly vulnerable and their maternal, obstetric and gynaecological services have to be given special priority.

<I>Source: Closing statement of WHO Tsunami Conference in Phuket, Thailand</I>