|Annals of Burns and Fire Disasters - vol. X -
n. 2 - June 1997
CO-OPERATION IN THE
MEDITERRANEAN AREA IN FIRE DISASTERS
of Medicine, Cairo University, Egypt
Co-ordinator, MBC Disaster Committee
This paper considers various aspects of co-operation in the Mediterranean area with regard
to fire disasters. The importance -f pieparedness,
education, and training is stressed: we should not wait passively for the next natural
disaster to strike, but rather mobilize knowledge
and technological know-how and give a positive response to the strong political interest
and commitment to the inter community. A survey is made of the various organizations
involved in the international response to disasters, with particular refeicocc to the
Mediterranean Club for Burns and Fire Disasters (MBQ. It is possible to prevent many
natural and all man-made disasters. 'I'lie MBC has compiled a list of volunteer task
forces willing to intervene in the event of a disaster. Efficient planning can always
reduce the impact of a disaster.
The area of
the Mediterranean Sea was the centre of the ancient world. The crossroads of three
continents, it is unique in the way it merges races, religions, cultures, civilitations,
and resources. The eighteen countries bordering the Mediterranean Sea have a population of
some 350 million. Since antiquity there has been a continuous move in crit to and fro of
people between east and west, north. The Phoenicians, great seamen that they were,
explored the corners of the Mediterranean and established and military posts in North
Africa. The Greeks and Poinans settled practically everywhere and the Mediterranean
witnessed a wealth of exchange of thoughts, and civilizations. Later it
became a lake belonging to lie then rising Arab Empire.
That ancient civilization was the
cradle of the newbom spirit of the Mediterranean of which we are all so proud and which
still survives today, proving that co-existence is ti only possible but also a must,
particularly in this world ol modern technology, communications, and transport. The ,lrp,i
presents similarities and disparities, but even the -1 is p, arities are points
of union and strength.This introduction would suggest that co-operation on 1 levels and
particularly in the field of fire disasters is not : justified for humanitarian and
neighbourhood considetal ions but also as a scientific and sociocultural necessity.
Disaster is defined as any occurrence that causes damage, ecological disruption, loss of
human life, and deterioration of health and health services on a scale sufficient to
warrant an extraordinary response from outside the affected community or area. On the
basis of this definition, can one suppose that the Mediterranean area is subject to fo,
Fire disasters are liable to occur in this area as in other parts of the world. We know of
the disaster that destroyed the famous Alexandria Library with its thousands of valuable
documents and books. Fire disasters may be of natural or man-made origin. The former
include volcanic eruptions and forest fires as well as fires that may follow natural
disasters such as floods and earthquakes. Among manmade fire disasters are those occurring
in oilfields and petrochemical plants and BLEVE (boiling liquid expanding vapour
explosion), which is always a hazard when handling liquid petroleum gas. Tankers on the
high sea transporting thousands of tons of oil are also a potential threat. Explosions of
natural gas in city networks have occurred not infrequently since the introduction of this
type of energy in southern countries. Egypt suffers from village fires that sweep villages
during the hot season, kindled by sparks carried to the roofs of peasant houses where the
inhabitants store dried crop stems and hay used as fuel in their primitive ovens; this
causes millions of pounds of damage and exposes hundreds of human lives to the horror of
There is no reason why we should wait
passively for the next natural disaster to strike. We should mobilize scientific knowledge
and technological know-how. We should give a positive response to the strong political
interest and commitment to the international community" - thus Mr Boutrous Ghali,
former Secretary General of the United Nations, eloquently expressed the philosophy that
lies behind modem disaster management. Disaster medicine has been defined as "the
study and collaborative application of various health disciplines to the prevention,
immediate response, and rehabilitation of health problems arising from disasters, in
co-operation with other disciplines". At its 1991 meeting the WHO Expert Committee on
Emergency Relief Operations endorsed this definition and included it in its official
To be an effective and efficient managerial
system, disaster medicine has to be an extended method comprising all the phases and
facets of the disaster cycle, including preparedness, prevention, immediate response,
relief, reconstruction, rehabilitation, and development.
By their very nature, emergency preparedness and response programmes involve making plans
and preparations, some of which we hope will never be used. Yet it is necessary to make
such plans and preparations in order to be ready for the worst. Should Disaster Strike Be
Prepared! This was the slogan for World Health Day, 7 April 199 1, declared by WHO.
This requires active intersectorial operation and cooperation. It is not feasible that the
health section should shoulder the responsibility for the whole range of measures involved
in preparedness and response. Some of these measures are outside the jurisdiction of
Ministries of Health. Hence the importance of every country developing its own High
Disaster Council with multidisciplinary representation, a disaster code conforming to
international concepts and standards, and international collaboration.
Fire disasters have very special characteristics, if one considers the particularity of
the causative agent and the type of damage it produces in the human being. When fire comes
into contact with objects and material, it burns or destroys them in a relatively short time. The
action of fire on living organisms can be lethal within a few seconds. In man it
determines a pathological condition: the burn is considered to be the most complex trauma
that can strike the organism. A fire of vast proportions can cause damage to the
surrounding environment by the massive production of heat and the release of gases and
For the above reasons fire disaster management must be directed at planning measures
necessary to mitigate the damage caused to man and society and to prevent its aggravation.
A review of the literature makes it clear that international co-operation is directed
towards natural or man-made disaster in general, with very little attention paid to fire
disasters. I will therefore consider the different nature of fire disasters and their
management, together with proposals put forward by the MBC Disaster Committee.
With regard to co-operation in disaster management in the Mediterranean area, the United
Nations system is only one of the principal partners in disaster relief. The others are
the Red Cross, the Red Crescent, Non-Governmental Organizations (NGOs) including voluntary
agencies (VOLAGs), and bilateral donor countries. Collaboration between these sectors is
vital if international action is to be effective.
Since disaster definition so precisely indicates the need for outside help, it is very
important to stress the absolute necessity for better organization and coordination
of international assistance. This is a challenge of the first order, for the higher the
volume of international aid, the more complicated this task becomes. The Mediterranean
Club for Burns and Fire Disasters can contribute considerably and we shall discuss its
role within the context of NGOs.
in disasters: role of NGOs
Among the numerous
important NGOs active in the disaster field are the World Council of Churches, Caritas
Internationalis, Oxfam, the Islamic Relief Agency, the MBC, and many others. VOLAGs also
bring invaluable assistance in response to international appeals in the event of a
The Mediterranean Club for Burns
and Fire Disasters
Inspired by the
ideals of the late Professor Giovanni Dogo, the first meeting of burn specialists from the
Mediterranean area took place in 1983 in Palermo, Italy, during the 32nd National Congress
of the Italian Society of Plastic Surgery. The object was to engage the intellectual
forces of the Mediterranean countries in an open and extended confrontation to find out
more about the similarities, analogies, and differences in the prevention, treatment, and
functional recovery of burns, a dramatically frequent pathology in this region.
Apart from the various clinical viewpoints presented by the participants, all remarked on
the care and assistance required in the Mediterranean countries in the event of mass burns
following grave natural disasters or war, and on the need to draw up international
assistance plans based on the principle of co-operation among the countries of the region.
A common protocol was established, the object of which was to guarantee uniformity in
trends of research, teaching, and burns management. The participants also formulated the
need to create an organism of continuous consultation among burn specialists from the
The organism was given the name The Mediterranean Burns Club, with its seat at the
Division of Plastic Surgery and Burns Therapy, Civic Hospital, Palermo, Italy. The term
Club was expressly chosen to underline the friendship and the informal fellowship of its
members, inspired by the spirit of service. The official activity of the MBC began in
1988. Very rapidly the need to face fire disasters became an integral part of its
interests and the name was subsequently extended to The Mediterranean Club for Burns and
Fire Disasters. The aims of the Mediterranean Club for Burns and Fire Disasters are as
To encourage periodic
meetings of specialists from Mediterranean countries with the aim of verifying
similarihes, analogies, and differences and of studying the possible advantages of the
permanent reciprocal exchange of experiences.
To promote studies,
research, and programmes for young physicians on burn problems, ranging from prevenlion to
the psychological and functional recovery of the burn patient, with the aim of enriching
scientific, clinical, and therapeutic knowledge in the field of burns.
opportunities for young physicians and otirses to take part in continual exchanges between
the various centres in order to achieve greater integration of parOcular standards of care
and assistance, with the aim of relieving human suffering and at the same time encouraging
links o I Vriendship and brotherhood between different peoples.
To stimulate a
continuous effort to unite intellectual and material resources in a sustained spirit of
international co-operation in the field of care and assistance, particularly iii llie
event of disaster.
It is evident that the
aims of the MBC correspond to all llic aspects that should be taken into consideration in
the modem management of fire disaster, from prevention and preparedness to relief,
rehabilitation, and reconstruction. MBC activities for fire disaster management and
cooperation between Mediterranean countries The MBC is not here to replace any existing
organization on the contrary, it plays a very important role of prolmotion and
collaboration between all the existing groups, ()ncerned with burns and fire disasters and
is encounter considerable international appreciation for its activity. Disasters are
always sad and destabilizing situations ind disaster response has often been
unsatisfactory. To be inore successful the knowledge and mechanisms have to hc based on
more scientific considerations:
- prevention and preparedness
- immediate response and reliefreconstruction
Prevention of many
natural disasters is possible while prevention of all man-made disasters should be
possible. With this concept in mind the MBC carries out studies on "Forest Fire
Disaster and their Prevention". The aim is to conduct similar studies of prevention
of the commonest types of disasters and to establish a code of prevention which by incans
of communication with the national governments will be implemented in different sites,
e.g. petrochemical [actories, drilling fields, electricity plants, subways, etc. The same
applies to studies to establish codes also for the protection of buildings and public
facilities, e.g. stadiums, underground railway, schools, public transport, hospitals,
etc., to make sure they do not become death traps and will continue to function properly
after a disaster. The performance of repeated fire alarm tests in buildings and of fire
disaster drills, together with communication to the public by all available media
channels, will also prove of great importance to reduce casualties. The implementation of
civil defence and anti-fire measures in the various Mediterranean countries and use of the
same standard codes will make all aspects of fire disaster management simpler and more
efficient. This goal can be achieved in several ways:
production of series of
preventive notices, posters, alburns, brochures, slides, videotapes, etc. A commission for
"Prevention of Burns" coordinates the various aspetet of prevention in different
production in various languages of model clinical files to be used by physicians and
decentralized hospitals so that burn victims receive better and immediate treatment;
preparation of a common
clinical/therapeutic file for all burn centres in order to facilitate the exchange at
regional and international level of ideas, studies, research, and co-operation in teaching
and assistance. To communicate easily, people have to speak the same language.
For a state of preparedness to be achieved, it is necessary to collect information and
data obtained from the analysis of major disasters and to establish a data base. Though no
two disasters are alike, the problems that certain categories of disaster are likely to
create are quite foreseeable. Disasters have profiles and these should be established. The data should be available and interchanged
between the authorities of the different countries. The European Union relies upon the MBC
for liaison in its vast programme of civil defence. The World Association of Emergency and
Disaster Medicine (WADEM) has established close links with the MBC as a counsellor in the
sector of thermal agent damage. In view of the presence in the Club of various fire
disaster experts it is expected that this field of consultation will also expand.
In the past the traditional response to disasters has depended more on goodwill than
on knowledge. While this outpouring of personal and international solidarity has brought
great comfort to stricken populations, the effective results have been hampered by a lack
of knowledge and trained personnel at all levels.
To carry out studies and to put into operation what has been learned it is necessary to
have trained people. In this respect the MBC has been very resourceful through its
different institutional activities, namely its scholarships, its participation in
different scientific events, and its Conferences on Burns and Fire Disasters, as well as
its diffusion of acquired knowledge in the pages of Annals of Burns and Fire Disasters (formerly
known as Annals of the MBC).
The MBC has also participated in COMETT, the
European Community Programme for Education and Training in Technology. This is a
multimedia computerized teaching system in the field of burns and fire disaster. It is an
instrument proposed by the European Union to improve co-operation between universities,
research institutes and the world of business. The main purposes of the project are to
improve and make more uniform the level of professional specialization, to promote
activities in the field of prevention, therapy, and rehabilitation of burn patients, and
to improve care and rescue work in fire disaster. The CD-ROM produced by the MBC will be a
useful medical teaching aid at all events.
MBC training is offered at specialized training centres in the Mediterranean area, such as
San Marino (CEMEC) and Palermo. Education is intended for all those concerned with fire
disaster management, through workshops, integrated multidisciplinary courses, and drills
which are carried out on a periodic schedule. In addition to these various facilities
(scholarships etc.), the MBC provides, at its official seat in Palermo, equipment for the
storing of clinical, bibliography, didactic, and image data. An electronic Editing Centre
has been set up, as well as a Computer Graphic Centre and a Computer Animation Centre.
This has made it possible for the MBC to:
create a bibliographical
data-bank covering burns, reconstructive surgery, and fire disasters
create a clinical,
therapeutic, and assistance databank on the basis of information from the various Centres
in the Mediterranean area
collect and manage all
graphic and printed material for the promotion of prevention campaigns
produce and store images
to be used in teaching, scientific activity, and text editing
create a centre for the
electronic distribution of all data collected
create a centre for the
management of the various Club activities
Through its regional and
international recognition the MBC has also sponsored many training courses on burns and
fire disaster in a number of countries (e.g. Egypt, Syria, Lybia, Morocco, Pakistan).
The courses on burns and fire disasters in the CEMEC (European Centre of Disaster
Medicine) programme are co-ordinated on the scientific level by the MBC, at the division
of Plastic Surgery and Burns Therapy in Palermo.
The MBC is part of the United Nations
International Emergency Network (UNIENET).
Annually, and in rotation in the various capital cities, the Club organizes, meetings,
congresses, and training courses with the intention of promoting the integration of the
different types of culture in the sector of burns and fire disasters.
The MBC offers ten annual scholarships to be shared equally between physicians and nurses
to assist them to attend a Burn Centre of a Division of Burns or Plastic Surgery in a
country in the Mediterranean area. One of these scholarships is reserved for the United
Nations Organization IDNDR and one for the International Federation of Surgical Colleges.
The First International Congress on Fire Disasters was held in Palermo, with a very
distinguished international contribution. The Second Congress was held in 1992 and the
Third in June 1995. Two valuable volumes have resulted from these occasions.
The MBC is in the process of compiling lists of volunteers willing to intervene as a task
force (physicians, nurses, paramedicals, technicians) in this field to provide specific
advice in rescue work. To join these task forces, write to either the Secretariat of the
Club or the Co-ordinator of the Disaster Committee. The MBC is also on the Internet.
The creation of such task forces should be
communicated to the Civil Defence Ministries in each single country and to government
agencies. The MBC is prepared to be responsible for this. Any volunteer or other
participant must have previous training. The MBC would provide such training and would
also have a bank of people to call upon. The role of these task forces in relief
operations will be very valuable because of their training, the unification of systems,
and the integration of performance.
Immediate response and
In the event of a disaster
the MBC can be notified through the national representative or members of the disaster
committee. A special form will be available for the alert, so that data collected and
reported should be precise, concise, and very specific. This allows an accurate estimate
of the extent of the disaster, the number of victims, the availability of local resources,
and the help required, both quantitatively and qualitatively. Human contact between
colleagues working in the same field and acquainted with each other beforehand reduces the
amount of tirne lost and unnecessary help provided, besides promoting the proper
utilization of the scarce resources available.
Lack of precision in the alert, and poor judgment as to what is required, very often lead
to the arrival of unnecessary help, while really needed help never comes. We have has
experience in the Mediterranean and elsewhere of tents being sent too late, doctors and
nurses arriving where they were not needed, and the nature and extent of the damage being
Through WADEM, WHO has invited the MBC
as a consultant in fire disasters to provide experts and necessary data, as for example in
Azerbaijan, Moldova, and Poland.
The MBC plans to establish a central office which would receive the alert in the event of
fire disasters and coordinate relief work with the various UN agencies as well as national
governments and non-governmental organizations. The MBC, through its many institutional
activities and the great number of different specialities among its members, can also
provide the necessary experts in the post-relief phases and participate in reconstruction
on assignments in relation to local needs. It can also provide on request expertise in the
development of programmes aimed at fire disaster management.
The following twenty-two countries are now
Members of the MBC: Albania, Algeria, Bosnia, Croatia, Cyprus, Egypt, France, Greece,
Israel, Italy, Lebanon, Libya, Malta, Morocco, Portugal, San Marino, Slovenia, Spain,
Syria, Tunisia, Turkey, Yugoslavia. There are Associated Members from several
Great achievements are always the outcome of great ideas, which may at the outset seem no
more than a dream. Yet good faith in a concept and persistent efforts to achieve it will
always bring the best reward.
considère les divers aspects de la coopération dans la région méditerranéenne pour ce
qui concerne les désastres du feu. Il souligne l'importance de l'existence d'un état
permanent de préparation, d'éducation, et de formation: il ne faut pas attendre
passivement le prochain désastre naturel, mais plûtot mobiliser les connaissances
scientifiques et technologiques et donner une réponse positive aux forts intérêts
politiques et à l'engagement de la communauté internationale. Les diverses organisations
intéressées à la réponse internationale aux désastres sont décrites, et en
particulier le Club Méditerranéen des Brûlures et des Désastres du Feu (MBC). Il est
possible de prévenir la plupart des accidents naturels et tous les accidents dus à
l'action humaine. Le MBC a compilé une liste des corps expéditionnaires volontaires qui
ont offert leur assistance en cas de désastre. Une planification efficace peut toujours
réduire l'éffet d'un désastre.
- Gunn S.W.A.: "Multilingual Dictionary
of Disaster Medicine and International Relief". Kluwer Academic Publishers,
Dordrecht, 8.London, Boston: 1990.
- Gunn S.W.A.: The scientific basis of
disaster medicine. In: "The Management of Mass Burn Casualties and Fire
Disasters", Kluwer Academic Publishers, Dordrecht, London, Boston: 13-18, 1992.
- Ghali B.B. In: Schramm D., Management,
university, business and government linkages; global continuing education for disaster.
Proceedings of Sixth World Conference on Continuing Engineering Education: 477-83, 1995.
- Bitmer P.: Disaster Preparedness. A
Worthwhile Investment. The 1991 World Health Organization Infirmation Kit: 5-7, 199 1.
- Gunn S.W.A.: Personal communication, 1996.
- Gunn S.W.A.: The action of the
United Nations and the World Health Organization in disasters. Proceedings of the National
Seminar on Disaster Preparedness, Cairo, October 17-20: 5-13, 1983.
- United Nations Assembly Resolution 44/136,
December 1989, New York, USA: 1989.
- Preliminary Report of World Conference on
Natural Disaster Reduction, Yokohama, Japan: 1994.
- CEMEC, 9th
International Training Course, 23-27 October 1995a nd 2-24 November 1995.
- Masellis M., Gunn
S.W.A.: The Mediterranean Burns Club: Three years of action. Ann. Medit. Burns Club, 4:
- Masellis M., Costagliola M., Torres V.G.,
loannovich., Magliacani G.: A multimedia computerized teaching system in the field of
burns. Ann. Medit. Burns Club, 7: 121-7, 1994.
paper was received on 17 March 1997.
Address correspondence to: Prof. Mohammed Kadry,
Faculty of Medicine,
Cairo University, Cairo, Egypt.