Citation

Nates JL, Moyer VA. Lancet 2005; 366(9492): 1144-1146.

Affiliation

MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA. jlnates@mdanderson.org

Copyright

(Copyright © 2005, Elsevier Publishing)

DOI

10.1016/S0140-6736(05)67460-0

PMID

16198751

Abstract

Summary: A few weeks ago, Hurricane Katrina, a category 5 hurricane, stormed the Gulf coast of the USA, affecting an area as large as the UK. Katrina completely destroyed several communities, leading to the evacuation of millions of individuals. New Orleans, a major American city with a population of half a million inhabitants, was totally devastated and evacuated. This catastrophe follows on from the recent Asian tsunami. The worst, however, is that we knew of the catastrophic consequences of a powerful storm in that area of the USA and what we needed to do to reduce its impact. Last year, a simulation exercise in New Orleans, with a fictitious category 3 hurricane named Pam, predicted the scenario accurately, but funds to prevent the devastation were not allocated.

As we impotently watched television, the disaster unfolded. The hospital scenes of combined internal and external disasters already described in Houston (Nates JL. Crit Care Med 2004; 32(3):686-90) repeated, despite the fact that we have learned how to prevent them. The medical centres that were supposed to take care of the sick became overheated traps with no electricity, water, communication, and other vital services; despite knowing the hurricane was approaching, they were unprepared to deal with the consequences of flooding and to evacuate their patients. Local and national leaders underestimated the storm and failed to act in time.

In January, the UN took a big step forward in dealing with the prevention, management, recovery, and other critical aspects of disasters by adopting the Hyogo Framework for Action 2005 - 2015 Resolution. This resolution, which was partly based on the Yokohama Strategy and the Johannesburg Plan, addresses the specific gaps in present responses and challenges that disasters pose to communities around the globe. At the same time as organisations such as the Cochrane Collaboration and the US Centers for Disease Control and Prevention have groups dedicated to gather evidence-based data to better respond to these contingencies, we wonder what role all these resolutions and knowledge played in the decisions not to repair the New Orleans levees.

As we look at the whole picture, it appears that the poor outcome in many of these disasters is not the result of lack of knowledge but rather the result of inaction and poor implementation of the necessary measures to prevent, contain, or mitigate the impact of natural disasters on the populations exposed; this, of course, after discounting the enormity of the catastrophes involved. Memory of previous events in history is short; George Santayana once said, "He who forgets history is destined to repeat it". It seems to us that if we do not react soon with rapid and effective changes to our current emergency responses and leadership, we will knowingly and sadly be repeating history in many more opportunities to come.