Annals of Burns and Fire Disasters - vol. X - n. 2 - June 1997

CO-OPERATION IN THE MEDITERRANEAN AREA IN FIRE DISASTERS

Kadry M.

Fanculty of Medicine, Cairo University, Egypt
Co-ordinator, MBC Disaster Committee

SUMMARY. 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, disasters?
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 fire.
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 report.
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 fumes.
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.

International response 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 disaster.

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 attending countries.
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 follows:

1. 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.

2. 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.

3. To encourage 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.

4. 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
• rehabilitation
• development

Prevention and preparedness

1. 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 countries;

   • preparation and 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.

2. Preparedness
   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.

3. Education and training
   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.

4. Taskforce
   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 relief

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 misreported.
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 non-Mediterranean countries.
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.

RESUME. L'Auteur 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.

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