(First of Two Parts)
MANILA –When the stench of death and the wails of the bereaved fill the air, the advent of new life makes for great human-interest stories.
A child born on a roof surrounded by swirling waters. Those babies nicknamed “Bakwet” (a play on evacuate) in the aftermath of typhoons, earthquakes or conflict. Beyond these life-affirming tales is a painful truth: In disaster-prone places there is scant protection to be found for the community’s most vulnerable members.
Over 1 million people lost access to full health services following Super typhoon Yolanda (Haiyan). The international aid group, Save The Children, reports that more than 100 of an estimated 750 births daily in affected areas came with potentially life threatening complications.
“Four months after the typhoon, only half of affected health centers had reopened – meaning up to 45,000 babies were born without full medical care,” said Save The Children Philippines Country Director, Ned Olney.
In a briefing, Olney pointed out that when women die in childbirth following disasters, the family loses its primary caregiver. The surviving newborn babies could fail to thrive, and many do not survive beyond five years old, as they tend to be malnourished.
According to the NGO’s 2014 “State of the World’s Mothers” report, more than 60 million women and children are in need of humanitarian assistance this year. Over half of maternal and child deaths worldwide occur in crisis-affected places. “The majority of these deaths are preventable,” the report adds.
In a bid to ease mortality among mothers and newborns during disaster periods, Save The Children launched ‘the BEACON Box’ (Birthing Essentials And Care Of Newborns) program.
The kit, contained in a stormproof box, contains everything to enable a pregnant woman to give birth in a clean environment if she cannot get to a health clinic: plastic sheets, a tarpaulin, soap, sterile cord ties, sterile blades, clean towels, a birth certificate and a lamp. The aid group will preposition these supplies in the country’s most vulnerable barangays.
The project will cost P10 million.
Bracing for more loss
Disaster belts crisscross the world. But many governments lag in providing mothers and children with appropriate health services even during periods of strong economic growth.
In the Philippines, for example, per capita GDP has almost tripled since 2000. But a series of typhoons and a major earthquake in 2013 caused the country to slip four places in Save The Children’s global ranking of 178 countries.
The Philippines’ 2014 105th ranking is lower than neighboring Southeast Asia countries like Vietnam, Thailand, Malaysia and Singapore. Even Iraq, a country still recovering from a decades of war and terror, outranks the Philippines.
The official Yolanda death toll has topped 6,000, thrice the initial figure claimed by President Benigno Aquino III. Private rescue and relief groups say the actual death count is much higher as protocols do not include unidentified dead and the missing. The Philippine government estimates that Yolanda affected 16 million, more than 16 percent of the national population. At least 10 million of these were women and children.
Beyond the immediate death toll, however, loss in human lives could worsen this year.
Save The Children’s report cited research on impact of Philippine typhoons that indicate, “Almost 15 times as many infants may die in 2014 due to conditions that deteriorate in the wake of Haiyan than were killed outright by the storm itself.”
“Depressed incomes will leave families with less to spend on health care, education and nutritious food,” it added, noting that historically, female infants are most at risk post-disaster.
“More males than females die in the womb immediately after typhoons, as is well established. After being born, however, a baby girl’s risk of dying is higher even if she has no siblings, but it doubles if she has one or more older sisters, and quadruples if she has brothers,” it added. Save The Children cited a 2013 report, “Destruction, Disinvestment, and Death: Economic and Human Losses Following Environmental Disaster,” published in the Social Science Research Network.
Yolanda devastated more than 2,000 hospitals and health clinics and destroyed countless health records and computer systems, according to Save The Children. Six months after the disaster, only 50 percent of facilities have been restored.
Francesca Cuevas, Director of Health for Save the Children-Philippines however, notes that only 7 percent of health facilities in affected areas are able to provide clean and safe delivery. Only 4 percent of the health facilities can handle newborn that need resuscitation.
Greater health focus urged
Six months since Yolanda, Presidential Assistant for Rehabilitation and Recovery Panfilo Lacson says the Office of Civil Defense still needs to submit its Post Disaster Needs Assessment. The report is a requirement before the national government rolls out its rehabilitation masterplan.
There are Cabinet clusters to streamline the delivery of basic government services to communities in an archipelago of more than 7,100 islands. Lacson says only the infrastructure cluster has submitted a comprehensive rehab plan.
Critics have chafed at what they see as a bias for infrastructure at the expense of other crucial sectors.
There’s no overstating the need for infrastructure recovery. Yolanda damaged more than a million homes and destroyed 17500 public school classrooms in more than 2,000 schools.
Lacson says 200,000 housing units need rebuilding. Many private companies and foundations have rebuilt or have pledged to replace more than 2000 of the classrooms.
Save the Children and multilateral aid agencies have acknowledged the Philippine government’s “robust” response to the devastation of Yolanda. They urge the government, however, to step up efforts in providing jobs, shelter, and safeguards to prevent post-disaster abuse and exploitation of the most vulnerable sectors.
UN High Commissioner for Refugees (UNHCR) to the Philippines representative Bernard Kerblat noted, “gaps in aid provision of which, shelter and livelihood remain outstanding needs.”
The global charity Oxfam also expressed concern that the provision of jobs and livelihood lagged behind other services.
Kerblat said it best. After relief, the main challenge is putting “durable” solutions at the grassroots.
The World Health Organization, meanwhile, stressed the need to address longer-term health issues.
WHO country representative Dr. Julie Hall cited the need to provide safe health facilities for 70,000 births expected in the next three months. She also warned of mental health problems among those struggling to move on.
There have been many news reports of entire families perishing during Yolanda, and clans with only one or two surviving members.
“Six months on, we have made real progress, but the resilience of the Filipino spirit alone will not be enough,” Hall stressed.
“Ensuring the resilience of the health infrastructure, universal health care for all Filipinos, and continued investments in health promotion are all required,” she said.
Multilateral and private aid groups note the improvements in the delivery of health care in the Philippines, one of the world’s most disaster-prone countries. Save The Children, however, pointed out that, “without greater investment in disaster-proof health systems, and quicker and more effective humanitarian response, it may be increasingly challenging to keep rebuilding the country’s health infrastructure.”
“There are considerable inequities in health care access and outcomes between socio-economic groups, and a major driver of inequity has been the high cost of health care,” its report added.
The national insurance program, Philhealth states that 83 percent of the population is enrolled in what aims to be universal health coverage. Save The Children’s report, said that the covered rate (those who are actually able to go to a hospital) is estimated to be less than 75 percent, citing the PharmaBoardroom.com on Philippine healthcare coverage.
With local government systems still struggling to recover from Yolanda, aid groups urge President Aquino’s administration to invest more in basic health services. Resilience can only go so far. In the areas devasted by Yolanda, the 2013 earthquake and conflicts in Mindanao, defaulting on urgent health confirms could only increase the loss of human lives. (Inday Espina-Varona is Philippine Campaigns Director of Change.org, a global petition platform.)