EHJ February 2005, pages 8-11

The world watched in horror as the tsunami wreaked devastation around the Indian Ocean. Stuart Spear looks at how the profession can help in reconstruction and whether it has a role in humanitarian aid

According to Tony Lawler, an EHO and vice chair of the Irish Red Cross, the optimum age for an aid worker is someone in their 30s or 40s. "People in their early 20s often don't have the life skills to cope and for anyone over 50 the conditions are likely to be too debilitating." He also believes only certain types of people are suited to coping with the kind of trauma they are likely to witness in a crisis such as the one unfolding around the Indian Ocean, in the wake of the Indonesian tsunami. In some respects, he says, if you go later into a devastated region, the more traumatic the experience and the more psychologically robust you have to be. "In the first few days people want to get the basics, where are they going to live and where will they get food? But for a lot of people who have lost their whole families, the psychological impact of the tsunami is probably only just beginning now." He should know. Working for the Red Cross he has delivered aid around the world, including to a devastated Somalia during civil war and famine where the rule of law was dictated by 13-year-olds with Kalashnikovs.

The knee-jerk reaction for many EHPs as they watched the horror of the tsunami unfold, was that there must be something they could do to help. The United Nations was issuing dire warnings that death tolls would rocket unless devastated communities could be provided with safe water, sanitation and disease vectors could be controlled. Surely, this is exactly what environmental health is about? E-mails started to flood into the CIEH with offers of help while the charity's chief executive, Graham Jukes, held talks with local and central government representatives. The CIEH started putting together a list of EHPs with the skills to help and the International Federation of Environmental Health mobilised itself to see what it could do. EHPs on the RedR database, which acts as a recruitment agency for development and relief experts, prepared to be deployed.

But as the hours and days following the disaster turned to weeks it became apparent that despite its wealth of knowledge, the profession is not geared up to offer immediate relief in disaster situations. Now the question on everyone's lips is how can EHPs prepare to help in reconstruction, which is anticipated to go on for years, and be better prepared to respond more quickly next time there is a humanitarian disaster.

Stewart Petrie, co-founder of the charity Water for Kids and one of the few UK EHPs to be asked by the United Nations to visit the devastated region, has strong ideas on the subject. He wants to see an emergency EHP response team in place by next Christmas capable of responding immediately after a disaster. He envisages having 30 trained-up EHPs in sanitation, water, chlorination and disease control, who are fully inoculated. A fully-kitted team of 10 EHPs could be drawn from this group and be on the ground within 24-hours of an emergency. "They could operate through local environmental health associations in effected countries and pass training onto them. If you have 10 people with state-of-the- art equipment on the ground then within two weeks they could do 20 villages and provide up to 25,000 people with safe water," said Mr Petrie.

He also believes that a much more concerted effort should be made to forge links with local environmental health associations around the world. "If these structures were in place now we could be calling up what was left of the Sri Lankan association and asking them what they need," he said.

But making links with local environmental health associations is harder than it sounds. The International Federation for Environmental Health had been trying to forge links with public health officials in Indonesia for a number of years, but to no avail. "If people don't want to join us we can't force them," said the federation's president elect Colm Smyth. "Also, in many cases effected countries don't have organised structures. Or countries that do have organisations have them in name rather than in any formal sense."

He agrees with Mr Petrie that links should be forged where possible with local public health officials, but he also sees developing links with NGOs and aid agencies as key to providing conduits for EHPs to help.

"We are exploring the idea of NGOs using the IFEH as an information resource with a register of experts. Then when organisations are on the ground we can become a point of contact when they are looking for personnel." The advantage of the IFEH having such a database, believes Mr Smyth, is that EHPs with the relevant skills and training could be contacted in neighbouring countries or regions.

Mr Smyth envisages a network which could also be used in situations which may not necessarily get the attention of the international media, where advice or resources could be provided for public health teams facing local problems. But, he admits, for such a register to work a concerted effort must be made by the profession to educate aid agencies and NGOs about the skills EHPs have and how they could be applied in a crisis situation. All EHPs who have worked in aid and development agree the profession has been poor at selling itself to aid agencies as a resource in developing countries.

"Just joining RedR is not going to work, you need a way in," explains Mr Petrie. "Red R is not a relief agency, it is a training organisation that finds people for relief organisations and if Oxfam phones and says they want someone for water, RedR will punch a button on a computer. Generally Oxfam is not going to go for an EHP, as to them an EHP is someone in a white coat doing a food hygiene inspection."

Mr Lawlor, who has over 20 years' experience working with the Red Cross agrees that the profession is underselling itself. "The IFEH could usefully liaise with UN agencies and NGOs. Things could also be done at a national level with environmental health bodies having conversations with national aid agencies. We should fly the flag more."

One of the main advantages of working through the aid community is that each NGO or agency will have a clearly defined role in any humanitarian disaster. In partnership with governments and the UN, each NGO will have an agreed turf and an agreed role on that turf. This means then when working for an NGO everyone will have a defined role, for instance Oxfam is strong on water sanitation, and people there will have both the technical skills and psychological resilience to cope.

One thing that everyone in the aid community agrees on is that no-one should consider going into a crisis situation without suitable training and without being self sufficient in terms of accommodation and food supplies. Otherwise you are likely to just become a liability. An environmental health qualification and 10 years' experience in a local authority will not prepare you for what you will encounter. On arrival in a crisis zone aid workers are expected to hit the ground running and know what they are doing and how their role fits into the broader humanitarian aid network.

"You will also be expected to have the psychological ability to cope. Not everyone is suited to medium rehabilitation or short-term relief," warns Mr Lawlor. "You may also find that you are managing a situation in a developing country far beyond what you would ever get to do in your own country. You will have to take big decisions that would not be possible in the highly bureaucratised system of decision making in developed countries."

One of the agencies that offers the most comprehensive training for humanitarian aid and development is RedR. Here EHPs are encouraged to go on their intensive seven-day environmental health course. The course looks at the practicalities of vector control and sanitation, focusing on issues such as geography, climate, population density, immunity and insecticide resistance. Practical lessons are also taught on how to survey and design a water pipeline and how to install a basic water supply system. Other courses cover environmental impact assessments, project and management security in the field and personal security.

But according to Bobby Lambert, Red R's chief executive, the aid business is maturing as a sector which means that knowing how to dig a pit latrine is often not enough to qualify for being called up to help. "We have several thousand people on our database and the number of people who have been deployed worldwide during the tsunami is only around 30," he told EHJ. "There is much more local recruitment now and it is much less the case that you fly people out there. For example, there are loads of engineers in Sri Lanka, you don't need to fly more out."

Also, the skills needed may not necessarily come from the west. In Kosovo, RedR found themselves recruiting people from Kenya and Rwanda because they had more humanitarian experience. Staff from India have also been deployed to central America during the recent hurricanes.

That's not to say that EHPs from the west would not be used, it's just that the skills needed may be different from in the past. Mr Lambert explains: "Sometimes it can be finance people or management and co-ordination skills that are needed. We may be looking for people who have a reasonable technical background, for example in environmental health issues, but also who have a good enough knowledge of managing a large programme effectively."

Another reason that less NGOs are knocking on doors for help is that they already have their own experienced and battle-hardened workforce. "You get a churning of personnel between humanitarian aid and development. They are keen to keep management structures so you keep people with skills so that you do not keep making the same mistakes," said Mr Lambert. He admits, however, that there is still not enough continuity of staff.

So if an EHP wants to break into humanitarian and development work through NGOs, what is the best route? The answer, according to Bob Askew, an EHO who has worked for Oxfam and the Red Cross in Rwanda and who is now based in New Zealand, is persistence. It took him three years of "pestering" to get accepted by the Red Cross.

"Getting on board with an aid agency is a bit of a mystery," said Mr Askew. "But it's never too early to start making a place for yourself with someone like the Red Cross. Get involved with your local branch, they always need enthusiastic people. And don't worry if it takes ages, even years, it is the Red Cross's way of sorting out those with passion from the dreamers."

But for those wanting to do something more immediate local government links may provide the best opportunity. Over 100 local authorities have so far made contact with the Local Government International Bureau, which helps local authorities twin towns, offering help. Thirty councils have made concrete offers of help and are in the process of forging direct links with effected communities, often based on the profile of their populations. Merton LBC, with its large Tamil community is looking to forge links with northern Sri Lanka while Leeds is looking to twin with Colombo and Liverpool with Galle, also in Sri Lanka. Given the scale of the devastation in these areas any twining arrangements are likely to be long-term, lasting up to 15 years. Senior local government officials are currently visiting effected areas, talking to local and central government officials to see what help can be offered in the form of money, staff and aid. The LGIB will also be marrying local authorities capable of providing aid with those most in need.

Mat Wingate, international development programme manager for the LGIB and a former humanitarian officer for Oxfam, believes there may be cases where local government staff will be able to provide a unique resource. He agrees, however, that even in the development stage, staff going out to these areas should preferably have had exposure to development issues.

He told EHJ: "Local authority staff are uniquely placed in terms of engagement with their own communities and in terms of working through local government structures, which many staff in aid agencies don't have. We are looking for a sharing of expertise on local government mandated areas, around environmental health, education, developing structures of local governance."

The LGIB is also in talks with the Department for International Development to see where local government can fit into the overall national response. Sir Sandy Bruce Lockhart, chair of the Local Government Association, was in Thailand when the tsunami hit and is scheduled to meet Hilary Benn, secretary of state for international development, to discuss how to move local government involvement forward. Other local government bodies such as the Commonwealth Local Government Forum, the Society of Local Authority Chief Executives and the Convention of Scottish Local Authorities have joined the LGIB to form the Local Government Alliance for International Development to create a unified response to the disaster. The CIEH has been working closely with these bodies and is offering to help brief any EHPs being sent into the tsunami region.