ABSTRACT

This study aimed to analyze the actions taken by health management to deal with the criminal disaster of an oil spill off the coast of Pernambuco in 2019. It is a case study investigating the health sector’s actions in four municipalities in Pernambuco. Data was collected through interviews with 16 health department managers (municipal and state), using a semi-structured script with questions about performance, impacts, actions taken, difficulties, challenges, and lessons learned. The Collective Subject Discourse analysis revealed four thematic axes: a) managers’ perception of the impacts of the crime disaster; b) actions taken in the process of risk management of the disaster crime by the health sector; c) difficulties faced in the process of mitigating the disaster; d) evaluation of management actions during the disaster crime and future preparation. Weaknesses in health management were identified in disaster mitigation actions due to the need for more preparation of health services and professionals. The lack of instruments and coordination between the federated entities intensified the difficulties, generating calamity in the territory. This points to the need to build instruments and protocols to guide such actions in these situations so that activities can be carried out more efficiently and effectively.

KEYWORDS
Oil spill; Disaster; Disaster response; Health sector; Risk management

Introduction

The risk of oil spills at sea has significantly increased with the growth in the exploration, production, sale, and maritime transportation of petroleum. In 2022 alone, seven spills were recorded, with 15,000 tons of oil being released into international waters¹1 International Tanker Owners Pollution Federation. Oil Tanker Spill Statistics 2023. ITOPF [Internet]. 2023 [acesso em 2023 ago 2]. Disponível em: https://www.itopf.org/knowledge-resources/data-statistics/statistics/
https://www.itopf.org/knowledge-resource... . In Brazil, the record of oil spills at sea began in 1975, under the responsibility of state-owned oil company PETROBRAS, when 6,000 tons of oil were discharged into Guanabara Bay²2 Lawand Junior A, Silva CDA, Oliveira LPF. Derramamento de óleo no nordeste brasileiro: Responsabilização e desdobramentos. MLAW. 2021;1(1):84-113..

In 2019, the Brazilian coast was hit by more than 5,3 thousand tons of crude oil, first appearing in the State of Paraíba, then in Pernambuco, later spreading to the nine northeastern and two southeastern states³3 Santos MOSD, Santos CPS, Alves MJCF, et al. Oil in Northeast Brazil: mapping conflicts and impacts of the largest disaster on the country’s coast. An Acad Bras Ciênc. 2022;94(supl2):e20220014. DOI: https://doi.org/10.1590/0001-3765202220220014
https://doi.org/10.1590/0001-37652022202... ,⁴4 Pena PGL, Northcross AL, Lima MAG, et al. Derramamento de óleo bruto na costa brasileira em 2019: emergência em saúde pública em questão. Cad Saúde Pública. 2020;36(2):e00231019. DOI: https://doi.org/10.1590/0102-311X00231019
https://doi.org/10.1590/0102-311X0023101... . In this context, the spill seriously affected Pernambuco, where more than 1,6 tons of crude oil reached 70% of the beaches, polluting eight estuaries in 13 municipalities³3 Santos MOSD, Santos CPS, Alves MJCF, et al. Oil in Northeast Brazil: mapping conflicts and impacts of the largest disaster on the country’s coast. An Acad Bras Ciênc. 2022;94(supl2):e20220014. DOI: https://doi.org/10.1590/0001-3765202220220014
https://doi.org/10.1590/0001-37652022202... ,⁵5 Zacharias DC, Gama CM, Fornaro A. Mysterious oil spill on Brazilian coast: Analysis and estimates. Mar Pollut Bull. 2021;(165):112125. DOI: https://doi.org/10.1016/j.marpolbul.2021.112125
https://doi.org/10.1016/j.marpolbul.2021... ,⁶6 Soares MO, Teixeira CEP, Bezerra LEA, et al. Brazil oil spill response: Time for coordination. Science. 2020;367(6474):155. DOI: https://doi.org/10.1126/science.aaz9993
https://doi.org/10.1126/science.aaz9993... .

This oil release has caused a severe ecological disturbance to coral reefs and mangroves⁶6 Soares MO, Teixeira CEP, Bezerra LEA, et al. Brazil oil spill response: Time for coordination. Science. 2020;367(6474):155. DOI: https://doi.org/10.1126/science.aaz9993
https://doi.org/10.1126/science.aaz9993... , interrupting fishing and tourism, damaging the economic livelihood of fishermen⁷7 Ca LR, Pessoa VM, Carneiro FF, et al. Derramamento de petróleo no litoral brasileiro: (in)visibilidade de saberes e descaso com a vida de marisqueiras. Ciênc saúde coletiva. 2021;26(12):6027-2036. DOI: https://doi.org/10.1590/1413-812320212612.15172021
https://doi.org/10.1590/1413-81232021261... , and the population’s health because exposure to oil through breathing and skin contact is associated with signs/symptoms of headache, nausea, dizziness, skin irritation, and shortness ofbreath. Additionally, there are possible long-term effects, such as cancer, damage to the nervous system, and heart disease – and in cases of intense exposure, it may lead to coma and death⁸8 Secretaria Estadual de Saúde (PE). Intoxicações exógenas relacionadas à exposição ao petróleo no litoral de Pernambuco. Informe nº 05/2019. [local desconhecido]: Secretaria Executiva de Vigilância em Saúde; 2019..

Due to its magnitude and negative impact on the lives of communities and the environment, the uncertainty of responsibility, and the weakness of the response, this event can be characterized as a disaster crime⁹9 Freitas CM, Peres MCM. Relatório Técnico O desastre tecnológico envolvendo derramamento de petróleo no Brasil - Diagnóstico preliminar sobre lições apreendidas e perspectivas futuras para o setor saúde [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2021 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/56099
https://www.arca.fiocruz.br/handle/icict... ,¹⁰10 Araújo ME, Ramalho CWN, Melo PW. Pescadores artesanais, consumidores e meio ambiente: consequências imediatas do vazamento de petróleo no Estado de Pernambuco, Nordeste do Brasil. Cad Saúde Pública 2020;36(1):e00230319. DOI: https://doi.org/10.1590/0102-311X00230319
https://doi.org/10.1590/0102-311X0023031... , considering the damage caused and the conditions of vulnerability produced by a series of actions or omissions.

With the increasing frequency of disasters, especially those of technological origin, which are often more severe and widespread, it is crucial to prepare response strategies across all levels of government. In this context, risk management emerges as a key approach not only for disaster reduction through prevention and promotion but also for managing the aftermath through alert and response actions and for the recovery and rehabilitation of affected areas⁸8 Secretaria Estadual de Saúde (PE). Intoxicações exógenas relacionadas à exposição ao petróleo no litoral de Pernambuco. Informe nº 05/2019. [local desconhecido]: Secretaria Executiva de Vigilância em Saúde; 2019.,¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... . These efforts should be carried out collaboratively, involving multiple sectors, communities, and non-governmental organizations. This can be achieved by disseminating scientific and technological knowledge to inform and train the population, enabling them to participate effectively in these efforts, mitigate damage, and assist in the recovery of affected territories¹²12 Ministério da Integração Nacional (BR), Secretaria Nacional de Defesa Civil. Glossário de Defesa Civil: estudos de riscos e medicina de desastres [Internet]. 5. ed. Brasília, DF: MI; 2012 [acesso em 2021 ago 26]. Disponível em: https://fld.com.br/publicacao/glossario-de-defesa-civil-estudos-de-riscos-e-medicina-de-desastres/
https://fld.com.br/publicacao/glossario-... .

The ability to manage a disaster is closely tied to the level of development of the affected municipality, state, or country. These events expose the socio-environmental vulnerabilities of impoverished populations and reveal limitations in risk management, mitigation, and the restoration and reconstruction of living conditions and health for those impacted¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... .

Disasters are complex and require health managers to develop comprehensive strategies to mitigate health risks. This involves a spectrum of services, from primary health care to surveillance and both intermediate and advanced levels of care, to address the full scope of damage and its underlying causes¹⁴14 Ministério da Saúde (BR), Fundação Nacional da Saúde. Protocolo de atuação da Funasa em situações de desastres [Internet]. Brasília, DF: Funasa; 2018 [acesso em 2021 ago 26]. Disponível em: http://www.funasa.gov.br/documents/20182/38937/PROTOCOLO_Atuacao_Desastres_2018+WEB.pdf
http://www.funasa.gov.br/documents/20182... .

In addition, ongoing actions are required after a disaster, integrating health efforts with socio-environmental and economic initiatives to support the population in rebuilding and recovering their living and health conditions. Moreover, public institutions, organized civil society, and even private entities must provide the conditions for the reconstruction of ‘normality’ to occur more sustainably and reduce the risks of a new disaster¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... ,¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... .

The fragility and scarcity of research on health management in the context of oil-related disasters highlight the need for studies from a public health perspective¹⁶16 Santos RC, Gurgel AM, Silva LIM, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... .

This article examines the actions undertaken by health management in response to the 2019 oil disaster in Pernambuco, highlighting the key challenges encountered and the lessons learned to enhance public health management practices.

Material and methods

Between 2021 and 2023, an exploratory qualitative case study was conducted in four coastal municipalities of Pernambuco that had over 70% of their coastline affected by the oil spill and accounted for 75.27% of the total oil collected across the state: Ipojuca, Cabo de Santo Agostinho, São José da Coroa Grande, and Jaboatão dos Guararapes.

The study targeted managers from the health departments of the affected municipalities and the state of Pernambuco who were involved in the response to the oil spill and consented to participate in the research. Participants were identified through the minutes of situation room meetings held during the disaster, which included health sector representatives (managers and/or coordinators) from the impacted municipalities. Additionally, the snowball sampling technique was used to identify interviewees, with a minimum of two participants from each department. At the end of each interview, participants were asked to recommend a coordinator or manager involved in the disaster mitigation efforts. Managers who had left their positions before the interview were excluded from the study.

The interviews were conducted using a semi-structured questionnaire with 28 questions, organized into five thematic blocks: a) the interviewee’s professional profile to gain insights into their background, training, and experience as a manager; b) perceptions of the disaster’s impacts, to assess the effects on the population’s socioeconomic conditions and health; c) actions taken by the health sector in managing the disaster crime, to explore the processes of disaster preparedness and response; d) challenges faced in disaster mitigation, such as difficulties accessing guiding documents and coordinating efforts among federal entities for crisis management; e) the management’s interaction with the population, to evaluate the level of social participation in the implemented actions; and f) an assessment of the actions taken during the disaster crime and preparedness for future events, focusing on the effectiveness of management and readiness for potential future incidents.

The interviews were digitally recorded, with an average duration of 50 minutes, and were conducted individually, except on two occasions when the interviewed managers invited their team to contribute. The recordings were then transcribed and organized into Excel® 2010 spreadsheets, using the Collective Subject Discourse (CSD) analysis technique to identify key expressions and central ideas. This process led to the definition of four categories of analysis: 1) Managers’ perceptions of the impacts of the disaster crime; 2) Actions taken by the health sector in managing the disaster crime; 3) Challenges faced during disaster mitigation; and 4) Evaluation of management’s actions during the disaster-crime and preparation for future disasters.

The study was approved by the Research Ethics Committee of the Aggeu Magalhães Institute, part of the Oswaldo Cruz Foundation (IAM/FIOCRUZ Pernambuco), under the Certificate of Ethical Appreciation Presentation (CAAE) No. 25398119.9.0000.5190 and opinion No. 5.037.340. It was conducted under Resolutions No. 466 of December 12, 2012, and No. 510 of April 7, 2016, issued by the National Health Council.

Results and discussion

Sixteen of the eighteen invited participants were interviewed, including ten municipal and six state workers. The group consisted of coordinators from various sectors: health surveillance (encompassing sanitary, epidemiological, and environmental surveillance, the Environmental Health Surveillance Center for Risks Associated with Disasters - VIGIDESASTRES, and Health Surveillance of Populations Exposed to Chemical Contaminants – VIGIPEQ), Primary Health Care (PHC), Occupational Health Surveillance, and the Toxicological Information and Assistance Center (CIATOX), as well as municipal managers. The participants had diverse educational backgrounds and varying levels of experience.

Of the sixteen participants, ten were female, and six were male. All had higher education degrees: six were nurses, two psychologists, one doctor, three veterinarians, one nutritionist, one biologist, one physiotherapist, and one pharmacist. The average experience in public health was 11.25 years, ranging from two to thirty-six years. Only four participants reported having experience with a major health event:

Professional experience and technical knowledge are crucial elements in conducting health actions, enabling faster and more effective responses¹²12 Ministério da Integração Nacional (BR), Secretaria Nacional de Defesa Civil. Glossário de Defesa Civil: estudos de riscos e medicina de desastres [Internet]. 5. ed. Brasília, DF: MI; 2012 [acesso em 2021 ago 26]. Disponível em: https://fld.com.br/publicacao/glossario-de-defesa-civil-estudos-de-riscos-e-medicina-de-desastres/
https://fld.com.br/publicacao/glossario-... .

The following presents the disaster management actions health managers took to mitigate damage, both in the affected municipalities and across the state of Pernambuco.

Managers’ perception of the impacts of disaster crime

The study sought to identify the impacts by examining how the disaster affected the socioeconomic conditions and health of the affected population. The findings highlighted multiple repercussions, notably in tourism, health, the economy, food and nutrition security, and local lifestyles. Socioeconomic and health problems were particularly significant (table 1), creating additional challenges for families who rely directly on the coastal and estuarine areas for their livelihoods.

The ban on fishing due to the potential contamination led to a loss of income for fishermen. This impacted the availability of one of the primary sources of food for these families and made it difficult for them to purchase other necessities. Other workers, such as merchants, were also affected by the closure of the beaches.

In Pernambuco, the commercial sale of shellfish and crustaceans fell by 80% to 100%, alongside a decline in the sales of other products¹⁰10 Araújo ME, Ramalho CWN, Melo PW. Pescadores artesanais, consumidores e meio ambiente: consequências imediatas do vazamento de petróleo no Estado de Pernambuco, Nordeste do Brasil. Cad Saúde Pública 2020;36(1):e00230319. DOI: https://doi.org/10.1590/0102-311X00230319
https://doi.org/10.1590/0102-311X0023031... . In some communities, fishermen were advised not to fish during the initial months of the COVID-19 pandemic as a biosafety measure, exacerbating the vulnerability caused by the disaster crime⁴4 Pena PGL, Northcross AL, Lima MAG, et al. Derramamento de óleo bruto na costa brasileira em 2019: emergência em saúde pública em questão. Cad Saúde Pública. 2020;36(2):e00231019. DOI: https://doi.org/10.1590/0102-311X00231019
https://doi.org/10.1590/0102-311X0023101... .

The repercussions on health encompassed both physical health, due to the effects associated with exposure to oil, and mental health, as a result of changes in the lifestyles of this population¹⁰10 Araújo ME, Ramalho CWN, Melo PW. Pescadores artesanais, consumidores e meio ambiente: consequências imediatas do vazamento de petróleo no Estado de Pernambuco, Nordeste do Brasil. Cad Saúde Pública 2020;36(1):e00230319. DOI: https://doi.org/10.1590/0102-311X00230319
https://doi.org/10.1590/0102-311X0023031... . As an atypical event, many municipalities were unprepared for such a situation, thus increasing risks and damage. The lack of readiness increased the population’s exposure to the risks, with several cases of people suffering from exogenous intoxication symptoms, such as dizziness, headaches, fever, and dermatitis, among others reported.

Despite complaining, many did not seek health services, making it difficult to notify and provide care. Some adopted homemade solutions to alleviate the symptoms, with reports of using toxic substances (such as kerosene) to remove oil residues from the body.

This population continued to be exposed to the substance through their work, as they could not afford to stop subsistence fishing due to the challenges of receiving emergency aid provided by the government to some affected families²⁰20 Silva LRC, Pessoa VM, Carneiro FF, et al. Derramamento de petróleo no litoral brasileiro: (in)visibilidade de saberes e descaso com a vida de marisqueiras. Ciênc saúde coletiva. 2009;14(4):1193-204. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... .

Another identified situation was the denial of the problems resulting from exposure to oil, considering the symptoms simple or an exaggeration of the population, or dismissing the possibility of people becoming ill due to exposure.

News reports have emerged about the disaster crime, many of them without highlighting the health issue or the seriousness of the impact on the region²¹21 Silva LIM, Antunes MBC, Albuquerque MSV, et al. O derramamento de petróleo no litoral pernambucano a partir das narrativas do Jornal do Commercio. Rev Eletron Comun Inf Inov Saúde. 2022;16(4):913-925. DOI: https://doi.org/10.29397/reciis.v16i4.3279
https://doi.org/10.29397/reciis.v16i4.32... . The lack of adequate and timely information may have left the population confused as to what to do about the situation. As a result of the poor communication about the problem²²22 Richetti GP, Milaré P. O Óleo no Nordeste Brasileiro: Aspectos da (an)alfabetização Científica e Tecnológica. RBPEC. Brasileira de Pesquisa em Educação em Ciências. 2021; (e29065):1-29. DOI: https://doi.org/10.28976/1984-2686rbpec2021u11871215
https://doi.org/10.28976/1984-2686rbpec2... , many were unable to identify whether the symptoms they were experiencing were related to the oil exposure.

Exposure to oil components can cause acute and chronic intoxication with damage appearing months or years after the event, regardless of the level and time of exposure, such as cancer, hematological diseases, disorders of the circulatory, pulmonary, renal, immune and neurological systems, emotional disorders, and hormonal imbalances²³23 Centro Brasileiro de Estudos de Saúde. Pela Declaração de Estado de Emergência em Saúde Pública para Controle dos Riscos Decorrentes da Maior Tragédia de Contaminação pelo Petróleo na Costa do Brasil | UFBA. Cebes [Internet]. 2019 out 28 [acesso em 2021 ago 26]. Disponível em: http://cebes.org.br/2019/10/pela-declaracao-de-estado-de-emergencia-em-saude-publica-para-controle-dos-riscos-decorrentes-da-maior-tragedia-de-contaminacao-pelo-petro-leo-na-costa-do-brasil-ufba/
http://cebes.org.br/2019/10/pela-declara... ,²⁴24 Aguilera F, Mendez J, Pasaro E, et al. Review on the effects of exposure to spilled oils on human health. J Appl Toxicol. 2010;30(4):291-301. DOI: https://doi.org/10.1002/jat.1521
https://doi.org/10.1002/jat.1521... .

These disasters impact mental health and provoke a catharsis of emotions among residents and those who depend on the sea for their livelihood. These communities have a symbiotic relationship with nature, which goes beyond economic aspects, encompassing cultural and spiritual dimensions that resonate in every aspect of their lives²⁵25 Euzebio C, Rangel G, Marques R. Derramamento de Petróleo e seus impactos no ambiente e na saúde humana. RBCIAMB. 2019;(52):79-98. DOI: https://doi.org/10.5327/Z2176-947820190472
https://doi.org/10.5327/Z2176-9478201904... ,²⁶26 Rung AL, Gaston S, Oral E, et al. Depression, mental distress, and domestic conflict among Louisiana women exposed to the deepwater horizon oil spill in the watch study. Environ Health Perspect. 2016;124(9):1429-1435. DOI: https://doi.org/10.1289/ehp167
https://doi.org/10.1289/ehp167... .

In this context, it is important to train healthcare professionals within the Unified Health System (SUS) not only to address intoxication cases but also to provide proper support and management of the mental health effects, ensuring ongoing care for the affected population¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... .

Actions taken in the disaster crime risk management process by the health sector

To characterize the actions carried out by the health sector in the disaster crime risk management process, the questions focused on preparing for and responding to the disaster. This involved forming a crisis committee, training health professionals, monitoring and notifying the exposed population, and health education actions.

The literature shows that oil-related disasters in Brazil, the United States, South Korea, and other countries have resulted in numerous consequences, necessitating a reorientation of their social protection systems to address the impacts generated²⁷27 Birkland TA, DeYoungy SE. Emergency response, doctrinal confusion, and federalism in the deepwater horizon oil spill. J Federalism. 2011;41(3):471-493. DOI: https://doi.org/10.1093/publius/pjr011
https://doi.org/10.1093/publius/pjr011... ,²⁸28 Santos RC, Gurgel AM, Silva LLM, Santos L, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,²⁹29 Hur JY. Disaster management from the perspective of governance: case study of the Hebei Spirit oil spill. Disast. Prevent. Manag. 2012;21(3):288-298. DOI: https://doi.org/10.1108/09653561211234471
https://doi.org/10.1108/0965356121123447... . However, the response actions to the oil spill were poorly coordinated, lacking integration among government agencies or coherent intersectoral strategies, diverging from the necessary recommendations that this situation required²⁷27 Birkland TA, DeYoungy SE. Emergency response, doctrinal confusion, and federalism in the deepwater horizon oil spill. J Federalism. 2011;41(3):471-493. DOI: https://doi.org/10.1093/publius/pjr011
https://doi.org/10.1093/publius/pjr011... ,²⁹29 Hur JY. Disaster management from the perspective of governance: case study of the Hebei Spirit oil spill. Disast. Prevent. Manag. 2012;21(3):288-298. DOI: https://doi.org/10.1108/09653561211234471
https://doi.org/10.1108/0965356121123447... .

In the case examined here, only one municipality managed to organize itself before the oil arrived, preventing disastrous situations such as population exposure to the substance. The other municipalities had to respond after the event occurred (table 2). Planned actions included establishing crisis committees, training healthcare professionals for support and treatment, and implementing measures for monitoring and reporting exposed individuals.

Due to the situation’s urgency, public authorities, fishermen, street vendors, local residents, and others mobilized to remove the oil from the beaches. These actions were carried out without adequate preparation, as most of those involved worked without Personal Protective Equipment (PPE) and without understanding the health risks, thereby exposing themselves to hazardous situations¹⁰10 Araújo ME, Ramalho CWN, Melo PW. Pescadores artesanais, consumidores e meio ambiente: consequências imediatas do vazamento de petróleo no Estado de Pernambuco, Nordeste do Brasil. Cad Saúde Pública 2020;36(1):e00230319. DOI: https://doi.org/10.1590/0102-311X00230319
https://doi.org/10.1590/0102-311X0023031... . Without prior preparation to minimize damage, the efforts were made in an unplanned, fragmented, and uncoordinated manner¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... ,¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... ,³⁰30 United Nations, Secretary-General for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2015 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/files/43291_sendaiframeworkfordrren.pdf
https://www.preventionweb.net/files/4329... ,³¹31 Oliveira M. Manual gerenciamento de desastres: sistema de comando de operações [Internet]. Florianópolis: Ministério da Integração Nacional, Secretaria Nacional de Defesa Civil; 2009 [acesso em 2022 ago 20]. Disponível em: https://www.ceped.ufsc.br/wp-content/uploads/2014/09/Manual-de-Gerenciamento-de-Desastres.pdf
https://www.ceped.ufsc.br/wp-content/upl... .

FORMING THE CRISIS COMMITTEE

All interviewees reported the formation of crisis committees to manage the disaster, composed of multiple sectors and professionals. Various departments were involved, including health coordination, fishermen, merchants, the tourism sector, non-governmental organizations, and other governmental agencies.

Crisis committees should be among the first measures taken in public health emergencies, as involving stakeholders from various backgrounds enables the planning and execution of strategic and effective actions¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... . It is crucial that, in addition to governmental bodies, these committees include representatives from affected communities, experts, and researchers with knowledge of the involved agents and related damages to combine community, technical, and scientific knowledge¹⁴14 Ministério da Saúde (BR), Fundação Nacional da Saúde. Protocolo de atuação da Funasa em situações de desastres [Internet]. Brasília, DF: Funasa; 2018 [acesso em 2021 ago 26]. Disponível em: http://www.funasa.gov.br/documents/20182/38937/PROTOCOLO_Atuacao_Desastres_2018+WEB.pdf
http://www.funasa.gov.br/documents/20182... ,¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... ,¹⁶16 Santos RC, Gurgel AM, Silva LIM, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,¹⁷17 Lefevre F, Lefevre AMC, Marques MCC. Discurso do sujeito coletivo, complexidade e auto-organização. Ciênc saúde coletiva. 2009;14(4):1193-1203. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,¹⁸18 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos e revoga as Resoluções CNS nos. 196/96, 303/2000 e 404/2008. Diário Oficial da União [Internet], Brasília, DF. 2013 jun 13 [acesso em 2023 ago 2]; Seção I:549. Disponível em: https://cep.ensp.fiocruz.br/sites/default/files/res_466J012.pdf
https://cep.ensp.fiocruz.br/sites/defaul... ,¹⁹19 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 510, de 7 de abril de 2016. Dispõe sobre as normas aplicáveis a pesquisas em Ciências Humanas e Sociais cujos procedimentos metodológicos envolvam a utilização de dados diretamente obtidos com os participantes ou de informações identificáveis ou que possam acarretar riscos maiores do que os existentes na vida cotidiana. Diário Oficial da União [Internet], Brasília, DF. 2016 maio 24 [acesso em 2023 ago 2]; Seção I:44. Disponível em: https://conselho.saude.gov.br/images/comissoes/conep/documentos/NORMAS-RESOLUCOES/Resoluo_n_510_-_2016_-_Cincias_Humanas_e_Sociais.pdf
https://conselho.saude.gov.br/images/com... ,²⁰20 Silva LRC, Pessoa VM, Carneiro FF, et al. Derramamento de petróleo no litoral brasileiro: (in)visibilidade de saberes e descaso com a vida de marisqueiras. Ciênc saúde coletiva. 2009;14(4):1193-204. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,²¹21 Silva LIM, Antunes MBC, Albuquerque MSV, et al. O derramamento de petróleo no litoral pernambucano a partir das narrativas do Jornal do Commercio. Rev Eletron Comun Inf Inov Saúde. 2022;16(4):913-925. DOI: https://doi.org/10.29397/reciis.v16i4.3279
https://doi.org/10.29397/reciis.v16i4.32... ,²²22 Richetti GP, Milaré P. O Óleo no Nordeste Brasileiro: Aspectos da (an)alfabetização Científica e Tecnológica. RBPEC. Brasileira de Pesquisa em Educação em Ciências. 2021; (e29065):1-29. DOI: https://doi.org/10.28976/1984-2686rbpec2021u11871215
https://doi.org/10.28976/1984-2686rbpec2... ,²³23 Centro Brasileiro de Estudos de Saúde. Pela Declaração de Estado de Emergência em Saúde Pública para Controle dos Riscos Decorrentes da Maior Tragédia de Contaminação pelo Petróleo na Costa do Brasil | UFBA. Cebes [Internet]. 2019 out 28 [acesso em 2021 ago 26]. Disponível em: http://cebes.org.br/2019/10/pela-declaracao-de-estado-de-emergencia-em-saude-publica-para-controle-dos-riscos-decorrentes-da-maior-tragedia-de-contaminacao-pelo-petro-leo-na-costa-do-brasil-ufba/
http://cebes.org.br/2019/10/pela-declara... ,²⁴24 Aguilera F, Mendez J, Pasaro E, et al. Review on the effects of exposure to spilled oils on human health. J Appl Toxicol. 2010;30(4):291-301. DOI: https://doi.org/10.1002/jat.1521
https://doi.org/10.1002/jat.1521... ,²⁵25 Euzebio C, Rangel G, Marques R. Derramamento de Petróleo e seus impactos no ambiente e na saúde humana. RBCIAMB. 2019;(52):79-98. DOI: https://doi.org/10.5327/Z2176-947820190472
https://doi.org/10.5327/Z2176-9478201904... ,²⁶26 Rung AL, Gaston S, Oral E, et al. Depression, mental distress, and domestic conflict among Louisiana women exposed to the deepwater horizon oil spill in the watch study. Environ Health Perspect. 2016;124(9):1429-1435. DOI: https://doi.org/10.1289/ehp167
https://doi.org/10.1289/ehp167... ,²⁷27 Birkland TA, DeYoungy SE. Emergency response, doctrinal confusion, and federalism in the deepwater horizon oil spill. J Federalism. 2011;41(3):471-493. DOI: https://doi.org/10.1093/publius/pjr011
https://doi.org/10.1093/publius/pjr011... ,²⁸28 Santos RC, Gurgel AM, Silva LLM, Santos L, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,²⁹29 Hur JY. Disaster management from the perspective of governance: case study of the Hebei Spirit oil spill. Disast. Prevent. Manag. 2012;21(3):288-298. DOI: https://doi.org/10.1108/09653561211234471
https://doi.org/10.1108/0965356121123447... ,³⁰30 United Nations, Secretary-General for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2015 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/files/43291_sendaiframeworkfordrren.pdf
https://www.preventionweb.net/files/4329... .

TRAINING PROCESSES FOR HEALTH PROFESSIONALS

Since there was no history of such events in the municipalities or the state, health managers and professionals lacked prior knowledge about the substance and its potential harm. This made it necessary to conduct training on the clinical management of poisoning, reporting procedures, organizing health services, establishing protocols, and defining workflows within the care network. Ongoing and continuous training is essential for improving health services and professional development¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... , contributing to enhancing service delivery¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... .

Preparing the health sector requires effective actions, such as creating and structuring strategic teams ready to respond to such situations¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... , like VIGIDESASTRES and the Strategic Information Center in Health Surveillance. Strengthening health surveillance helps prevent inadequate actions from becoming a new disaster, exacerbating a situation that could have been avoided with preventive measures¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹²12 Ministério da Integração Nacional (BR), Secretaria Nacional de Defesa Civil. Glossário de Defesa Civil: estudos de riscos e medicina de desastres [Internet]. 5. ed. Brasília, DF: MI; 2012 [acesso em 2021 ago 26]. Disponível em: https://fld.com.br/publicacao/glossario-de-defesa-civil-estudos-de-riscos-e-medicina-de-desastres/
https://fld.com.br/publicacao/glossario-... ,¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... ,¹⁴14 Ministério da Saúde (BR), Fundação Nacional da Saúde. Protocolo de atuação da Funasa em situações de desastres [Internet]. Brasília, DF: Funasa; 2018 [acesso em 2021 ago 26]. Disponível em: http://www.funasa.gov.br/documents/20182/38937/PROTOCOLO_Atuacao_Desastres_2018+WEB.pdf
http://www.funasa.gov.br/documents/20182... ,¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... ,¹⁶16 Santos RC, Gurgel AM, Silva LIM, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,¹⁷17 Lefevre F, Lefevre AMC, Marques MCC. Discurso do sujeito coletivo, complexidade e auto-organização. Ciênc saúde coletiva. 2009;14(4):1193-1203. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,¹⁸18 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos e revoga as Resoluções CNS nos. 196/96, 303/2000 e 404/2008. Diário Oficial da União [Internet], Brasília, DF. 2013 jun 13 [acesso em 2023 ago 2]; Seção I:549. Disponível em: https://cep.ensp.fiocruz.br/sites/default/files/res_466J012.pdf
https://cep.ensp.fiocruz.br/sites/defaul... ,¹⁹19 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 510, de 7 de abril de 2016. Dispõe sobre as normas aplicáveis a pesquisas em Ciências Humanas e Sociais cujos procedimentos metodológicos envolvam a utilização de dados diretamente obtidos com os participantes ou de informações identificáveis ou que possam acarretar riscos maiores do que os existentes na vida cotidiana. Diário Oficial da União [Internet], Brasília, DF. 2016 maio 24 [acesso em 2023 ago 2]; Seção I:44. Disponível em: https://conselho.saude.gov.br/images/comissoes/conep/documentos/NORMAS-RESOLUCOES/Resoluo_n_510_-_2016_-_Cincias_Humanas_e_Sociais.pdf
https://conselho.saude.gov.br/images/com... ,²⁰20 Silva LRC, Pessoa VM, Carneiro FF, et al. Derramamento de petróleo no litoral brasileiro: (in)visibilidade de saberes e descaso com a vida de marisqueiras. Ciênc saúde coletiva. 2009;14(4):1193-204. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,²¹21 Silva LIM, Antunes MBC, Albuquerque MSV, et al. O derramamento de petróleo no litoral pernambucano a partir das narrativas do Jornal do Commercio. Rev Eletron Comun Inf Inov Saúde. 2022;16(4):913-925. DOI: https://doi.org/10.29397/reciis.v16i4.3279
https://doi.org/10.29397/reciis.v16i4.32... ,²²22 Richetti GP, Milaré P. O Óleo no Nordeste Brasileiro: Aspectos da (an)alfabetização Científica e Tecnológica. RBPEC. Brasileira de Pesquisa em Educação em Ciências. 2021; (e29065):1-29. DOI: https://doi.org/10.28976/1984-2686rbpec2021u11871215
https://doi.org/10.28976/1984-2686rbpec2... ,²³23 Centro Brasileiro de Estudos de Saúde. Pela Declaração de Estado de Emergência em Saúde Pública para Controle dos Riscos Decorrentes da Maior Tragédia de Contaminação pelo Petróleo na Costa do Brasil | UFBA. Cebes [Internet]. 2019 out 28 [acesso em 2021 ago 26]. Disponível em: http://cebes.org.br/2019/10/pela-declaracao-de-estado-de-emergencia-em-saude-publica-para-controle-dos-riscos-decorrentes-da-maior-tragedia-de-contaminacao-pelo-petro-leo-na-costa-do-brasil-ufba/
http://cebes.org.br/2019/10/pela-declara... ,²⁴24 Aguilera F, Mendez J, Pasaro E, et al. Review on the effects of exposure to spilled oils on human health. J Appl Toxicol. 2010;30(4):291-301. DOI: https://doi.org/10.1002/jat.1521
https://doi.org/10.1002/jat.1521... ,²⁵25 Euzebio C, Rangel G, Marques R. Derramamento de Petróleo e seus impactos no ambiente e na saúde humana. RBCIAMB. 2019;(52):79-98. DOI: https://doi.org/10.5327/Z2176-947820190472
https://doi.org/10.5327/Z2176-9478201904... ,²⁶26 Rung AL, Gaston S, Oral E, et al. Depression, mental distress, and domestic conflict among Louisiana women exposed to the deepwater horizon oil spill in the watch study. Environ Health Perspect. 2016;124(9):1429-1435. DOI: https://doi.org/10.1289/ehp167
https://doi.org/10.1289/ehp167... ,²⁷27 Birkland TA, DeYoungy SE. Emergency response, doctrinal confusion, and federalism in the deepwater horizon oil spill. J Federalism. 2011;41(3):471-493. DOI: https://doi.org/10.1093/publius/pjr011
https://doi.org/10.1093/publius/pjr011... ,²⁸28 Santos RC, Gurgel AM, Silva LLM, Santos L, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,²⁹29 Hur JY. Disaster management from the perspective of governance: case study of the Hebei Spirit oil spill. Disast. Prevent. Manag. 2012;21(3):288-298. DOI: https://doi.org/10.1108/09653561211234471
https://doi.org/10.1108/0965356121123447... ,³⁰30 United Nations, Secretary-General for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2015 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/files/43291_sendaiframeworkfordrren.pdf
https://www.preventionweb.net/files/4329... ,³¹31 Oliveira M. Manual gerenciamento de desastres: sistema de comando de operações [Internet]. Florianópolis: Ministério da Integração Nacional, Secretaria Nacional de Defesa Civil; 2009 [acesso em 2022 ago 20]. Disponível em: https://www.ceped.ufsc.br/wp-content/uploads/2014/09/Manual-de-Gerenciamento-de-Desastres.pdf
https://www.ceped.ufsc.br/wp-content/upl... ,³²32 Rêgo RF, Müller JS, Falcão IR, et al. Vigilância em saúde do trabalhador da pesca artesanal na Baía de Todos os Santos: da invisibilidade à proposição de políticas públicas para o Sistema Único de Saúde (SUS). Rev Bras Saúde Ocup. 2018;43:e10s. DOI: https://doi.org/10.1590/2317-6369000003618
https://doi.org/10.1590/2317-63690000036... .

Some municipalities recognized the need to deploy health teams to the affected areas by setting up health bases to monitor the population, provide guidance, offer support, and handle the necessary reporting. However, only one municipality prepared its professionals and health network to respond to this disaster crisis. The shortcomings in the preparedness of the municipalities and the state, which delayed responses in certain situations, led to increased exposure and escalated risk scenarios.

Disasters of significant magnitude call for a joint effort from federal entities to mitigate damage, coordinated through intersectoral collaboration. The Health Emergency Operations Center (COE-SAÚDE) serves as the hub for this coordination, connecting all stakeholders responsible for disaster response with the General Emergency Operations Committee (COE-GERAL). The COE-Geral’s role is to ensure a unified and effective response to the disaster)¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹⁶16 Santos RC, Gurgel AM, Silva LIM, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... .

The main actions carried out by the federal entities were monitoring, case notification, and health education. As soon as the oil hit the beaches, the municipalities began to manage the situation. Each entity developed actions at different levels, depending on their level of preparedness. According to the state managers, when the oil reached the coast, they didn’t know how to act, making it difficult to monitor and support the actions of the municipalities. As a result, the state’s actions were carried out in response to emerging demands.

Based on the notifications, the state sent teams to the affected areas to conduct a situational assessment. Technical notes were issued to the population and healthcare professionals regarding reports of intoxications, which, due to the severity of the issue, became mandatory for immediate reporting. Additionally, weekly bulletins were produced. The state of Pernambuco was considered the link between the Ministry of Health (MS) and the municipalities, with contact established through situation room meetings.

HEALTH MONITORING AND SURVEILLANCE OF THE EXPOSED POPULATION

Local managers prioritized monitoring the cases of people who had come into contact with the substance and showed signs of exogenous intoxication and preventing further exposure. They organized support for the volunteers who were removing the substance from the beach, providing PPE to minimize direct contact. At first, there was no specific instrument for notifying those exposed, which led to the use of exogenous intoxication forms from the Notifiable Diseases Information System (SINAN), even in the absence of clinical manifestations indicating a case.

A reported challenge was the lack of knowledge about the substance and its impact on the fish. Laboratory analyses were conducted to determine if the fish were contaminated, but the absence of reference standards for acceptable levels of toxic compounds meant that neither the municipalities nor the state issued guidelines on the suspension, restriction, or special recommendations for fish consumption.

This led to difficulties between the state and municipalities because the media influenced the suspension of fish consumption. Additionally, research institutions recommended the same action after identifying petroleum in the digestive and respiratory systems of fish, shellfish, mollusks, and crustaceans, ultimately leading to advisories against consuming food from these areas³³33 Kelmo F. Efeito das manchas de óleo sobre as comunidades bentônicas recifais. O que podemos tirar após 08 meses de derramamento de óleo no litoral nordestino? In: Universidade Federal da Bahia. Congresso virtual UFBA 2020 [Internet]. [local desconhecido]; UFBA; 2020 maio 27 [acesso em 2022 ago 20]. Disponível em: https://www.youtube.com/watch?v=aAah-u-Sdp4c
https://www.youtube.com/watch?v=aAah-u-S... ,³⁴34 Silva DCP, Melo CS, Oliveira AB, et al. Derramamento de óleo no mar e implicações tóxicas da exposição aos compostos químicos do petróleo. Rev Cont Saúde. 2022;21(44):332-344. DOI: https://doi.org/10.21527/2176-7114.2021.44.11470
https://doi.org/10.21527/2176-7114.2021.... .

Ideally, in areas affected by a spill, the levels of toxicologically/ecotoxicologically relevant contaminants in economically relevant species consumed by the population, the capacity to adopt mitigation measures, the response capacity of local health systems, the relationship between socio-economic impacts and impacts on food and nutritional sovereignty and security resulting from the suspension or restriction of consumption, among others, should be assessed so that decisions can be made as to whether to continue trading in and consuming potentially contaminated food³⁵35 Secretaria da Saúde do Estado (BA). Protocolo de avaliação da saúde de população exposta a petróleo: orientações para serviços e trabalhadores da saúde da Bahia [Internet]. Salvador: Sesab; 2021 [acesso em 2022 ago 20]. Disponível em: https://www.saude.ba.gov.br/wp-content/uploads/2021/11/Protocolo-Petroleo_4nov2021-1.pdf
https://www.saude.ba.gov.br/wp-content/u... . Unfortunately, this was not observed in the studied state and its municipalities.

HEALTH EDUCATION ACTIONS

Health education efforts aimed to help the population avoid contact with the oil spill. These efforts included distributing informational pamphlets, training community health workers and disease control agents on preventive actions, and providing guidance on properly using PPE for professionals and volunteers involved in the oil cleanup. In one municipality, health education initiatives were also carried out in schools, encouraging children and adolescents to share this information with their families, neighbors, and friends.

Community leaders were invited to join the crisis committee to identify their needs and demands, thus creating a bridge between the authorities and the community. This also highlighted the importance of building a grassroots surveillance system. In addition, meetings were held with leaders of the fishing colonies to talk about the symptoms and what to do in the event of exposure. Additionally, there were training and discussion groups with waterfront workers, shopkeepers, hoteliers, and beachgoers at the fishermen’s colony and association, all aimed at preventing contact with the substance.

Social participation is fundamental in the disaster management process. Given their knowledge of the territory and their links with community members, social workers help to map the most vulnerable areas and groups, health facilities, alternatives, and other elements that technicians are unaware of¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... ,¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... ,³⁰30 United Nations, Secretary-General for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2015 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/files/43291_sendaiframeworkfordrren.pdf
https://www.preventionweb.net/files/4329... ,³⁶36 Organização das Nações Unidas, Estratégia Internacional para a Redução de Desastres. Marco de Ação de Hyogo 2005-2015: aumento da resiliência das nações e das comunidades frente aos desastres [Internet]. Genebra: ONU; 2005 [acesso em 2022 ago 20]. Disponível em: https://educacao.cemaden.gov.br/midiateca/marco-de-acao-de-hyogo-2005-2015aumento-da-resiliencia-das-nacoes-e-das-comunidades-frente-aos-desastres/
https://educacao.cemaden.gov.br/midiatec... .

Recognizing the importance of teamwork in disaster situations is essential. It supports the identification and triage of victims, health education for communities, and the need for diagnosis and treatment. However, it’s the effective access to healthcare, including psychological support, that truly makes a difference in disaster response and recovery efforts³⁷37 Silva MH. Desastres em saúde: desenvolvimento de um curso para trabalhadores da atenção primária à saúde [dissertação]. Rio Grande do Sul: Universidade Federal do Rio Grande do Sul; 2020. 113 p..

Even though exposure to oil components is associated with severe health outcomes, the managers’ statements did not reveal the adoption of adequate measures to increase the sensitivity of reporting suspected cases of poisoning. Furthermore, there was no evidence of health professionals being trained to diagnose these cases, establishing population cohorts for longitudinal monitoring of signs and symptoms potentially related to exposure, or other necessary actions.

Difficulties faced in the disaster mitigation process

The challenges encountered in the disaster mitigation process stemmed from a need for knowledge about guiding documents and difficulties in coordination among federal entities. Several factors hindered the development of practical actions: the absence of a guiding framework for organizing responses to technological disasters, which led to improvised efforts; a lack of understanding of the municipality’s epidemiological profile, which made it difficult to implement more effective and targeted actions to address potential health impacts associated with the disaster; and poor coordination among federal entities, which delayed the response of some managers as they awaited guidance on how to address the problem, given the need for a tripartite approach.

LACK OF KNOWLEDGE ABOUT GUIDING DOCUMENTS

Without official guiding documents and due to a lack of coordination, communication, and planning among federal entities, each entity sought any available data source for guidance. One municipality used the actions taken in Brazil’s Southeast region for oil spill situations as a model, focusing on reducing public contact with the substance to prevent potential health damage. Another municipality drew on examples from other countries that had faced similar situations to guide their actions. A third municipality developed an action plan during the process, which further slowed the response, and utilized the VIGIDESASTRES’ Emergency Response Preparedness (ERP) plan, adapting it to the situation despite its general nature. The state adapted the ERP for floods in Pernambuco³⁸38 Secretaria Estadual de Saúde (PE). Plano de Contingência Estadual para Enfrentamento de Desastres de Origem Natural com Ênfase em Enchentes e Inundações. Pernambuco: Secretaria Estadual de Saúde; 2010. to address the context of the oil spill. Additionally, another municipality used available resources from the SUS, such as the exogenous notification form, which had to be adapted for the case.

At the time of the disaster, the National Contingency Plan for Oil Pollution Incidents was in force and could have been adopted to guide the actions of local managers. This plan provides broad guidelines with a focus on coordinating disaster response³⁹39 Presidência da República (BR). Decreto nº 8.127, de 22 de outubro de 2013. Institui o Plano Nacional de Contingência para Incidentes de Poluição por Óleo em Águas sob Jurisdição Nacional, altera o Decreto nº 4.871, de 6 de novembro de 2003, e o Decreto nº 4.136, de 20 de fevereiro de 2002, e dá outras providências. Diário Oficial da União, Brasília, DF. 2013 out 23; Seção I:4.. During and after this disaster, additional documents with more specific response actions were published⁴⁰40 Ministério da Saúde (BR). Nota informativa sobre a atuação da Funasa em relação ao desastre ambiental ocasionado pelo derramamento de óleo no Nordeste. Brasília, DF: Ministério da Saúde; 2019.,⁴¹41 Fundação Oswaldo Cruz (BR), Instituto Aggeu Magalhães, Departamento de Saúde Coletiva, Laboratório de Saúde, Ambiente e Trabalho. Carta aberta pela declaração de estado de emergência em Saúde Pública diante dos perigos da exposição ao óleo de Petróleo nas praias nordestinas e para o desenvolvimento de ações de vigilância popular e cuidado em Saúde. Blog Combate Racismo Ambiental [Internet]. 2019 out 29 [acesso em 2022 ago 20]. Disponível em: https://racismoambiental.net.br/2019/10/29/carta-aberta-pela-declaracao-de-estado-de-emergencia-em-saude-publica/
https://racismoambiental.net.br/2019/10/... .

Technical notes were issued to provide guidance to the public. However, it’s important to consider that these documents use formal language and may not be accessible to everyone. They were distributed via the Internet, yet the majority of those directly affected are socio-economically vulnerable, with low levels of education and limited access to technology. Thus, it is crucial to consider the target audience and develop more accessible communication methods.

Insufficient measures were taken to mitigate the disaster, primarily due to a lack of planning, leading to a delayed response that failed to protect the population exposed to the oil in the affected areas.

DIFFICULTIES IN COORDINATION BETWEEN FEDERATED ENTITIES

Difficulties were identified in articulating and organizing responses between the federal entities. State management attempted to provide standardized information by issuing technical information notes and holding meetings to avoid response deficiencies.

Some municipalities received minimal and delayed support from the Ministry of Health and the State Health Department. This was mentioned as the main reason for the difficulty in determining what actions to take and how to implement them, based on the organizational principle of the SUS of tripartite management. It was also due to the great magnitude of the event, in which, in theory, the federal level should have assumed leadership and guided the other federal entities in decision-making.

Soares⁶6 Soares MO, Teixeira CEP, Bezerra LEA, et al. Brazil oil spill response: Time for coordination. Science. 2020;367(6474):155. DOI: https://doi.org/10.1126/science.aaz9993
https://doi.org/10.1126/science.aaz9993... reports that the federal government’s inaction or late action intensified the disaster’s harmful effects on the environment and the lives and health of communities. In this context, there was a delay in implementing the contingency plan, which should have been improved according to the situation, with more specific guidelines for local administrations and a delay in providing support to the other federal entities.

Tripartite management points out that when the municipality is unable to meet the demands of its territory, it can request support from other cities in its health region that have a greater capacity for physical and financial resources through the Regional Health Management, the state, and the federal government.

In the event of an oil spill, the MS is responsible for mobilizing the SUS and supporting prevention, preparedness, and response actions. This includes supporting the Executive Committee and the Monitoring and Evaluation Group in proposing guidelines for implementing the National Contingency Plan and guiding and supporting the SUS management spheres in the definition, execution, evaluation, and monitoring of such actions³⁹39 Presidência da República (BR). Decreto nº 8.127, de 22 de outubro de 2013. Institui o Plano Nacional de Contingência para Incidentes de Poluição por Óleo em Águas sob Jurisdição Nacional, altera o Decreto nº 4.871, de 6 de novembro de 2003, e o Decreto nº 4.136, de 20 de fevereiro de 2002, e dá outras providências. Diário Oficial da União, Brasília, DF. 2013 out 23; Seção I:4..

Political limitations also emerged in the statements of local managers, leading to difficulties in carrying out mitigation actions. Managers had to temper their language and decision-making to avoid conflicting with the economic interests of the local power holders.

Most municipalities in Pernambuco are small, which means they have access to fewer resources. This limitation affected disaster management, resulting in limited resources for acquiring materials, hiring professionals to address the crisis, and implementing other necessary measures.

Evaluation of management actions during the disaster crime and preparation for future disasters

At this stage, an effort was made to identify the managers’ perceptions regarding the management’s performance, strengths, challenges, and lessons learned. Some managers believed they could respond quickly to the population, even considering the unusual nature of the event. Only one municipality managed to prevent significant health impacts by organizing before the oil arrived, avoiding or reducing direct exposure. The support provided by the state government in some municipalities was highlighted as a facilitator. Another point raised was the technical competence of the teams, despite their lack of preparation for dealing with such a situation (table 3).

Faced with the possibility of a disaster, efficient and timely communication between health services and the population is essential. Local media outlets have been identified as quick strategies for reaching the population and disseminating warning messages about the dangers of a disaster and its consequences, especially for at-risk communities. This communication is used as a technological tool to control risk situations and protect and promote health, both environmental and occupational⁴²42 United Nations; United Nations International Strategy for Disaster Reduction. Bangkok principles for the implementation of the health aspects of the Sendai framework for disaster risk reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2016 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/publication/bangkok-principles-implementation-health-aspects-sendai-framework-disaster-risk
https://www.preventionweb.net/publicatio... .

Managers’ experiences, whether positive or negative, have resulted in an accumulation of knowledge. Moreover, they can guide best practices in the event of a future disaster, raising awareness of the importance of drawing up and implementing action plans early on, led by a qualified technical team.

It is crucial to consider the need for ongoing education and training for professionals, especially given the context of public health in Brazil, where a significant portion of management positions are filled through political appointments. This can lead to high turnover and low technical qualifications among professionals. Additionally, the demands of daily service dynamics and the various health situations faced regularly, along with the complex overlap of health and socio-environmental issues, limit the ability to address other priorities.

Freitas¹¹11 Freitas CM, Mazoto ML, Rocha V, organizadores. Guia de preparação e respostas do setor saúde aos desastres [Internet]. Rio de Janeiro: Fiocruz; 2018 [acesso em 2021 ago 26]. Disponível em: https://www.arca.fiocruz.br/handle/icict/40925
https://www.arca.fiocruz.br/handle/icict... emphasizes promoting continuing education for health professionals by conducting periodic training with simulated exercises for disaster situations to test and update the eslished plan.

Technical reports detailing the actions taken, methods used, challenges, and successes achieved are valuable for current and future management. They provide insights to the manager so as not to repeat mistakes and allow successful experiences to be replicated¹⁴14 Ministério da Saúde (BR), Fundação Nacional da Saúde. Protocolo de atuação da Funasa em situações de desastres [Internet]. Brasília, DF: Funasa; 2018 [acesso em 2021 ago 26]. Disponível em: http://www.funasa.gov.br/documents/20182/38937/PROTOCOLO_Atuacao_Desastres_2018+WEB.pdf
http://www.funasa.gov.br/documents/20182... .

It was observed that services, professionals, and management lack preparation to respond to such situations. There is no prior planning or mobilization for implementing disaster risk management, leaving the region vulnerable to these events.

Health management should maintain a process of monitoring, evaluation, and actions focused on disaster risk management. To achieve this, it is recommended that disaster management indicators be integrated with health indicators⁴⁰40 Ministério da Saúde (BR). Nota informativa sobre a atuação da Funasa em relação ao desastre ambiental ocasionado pelo derramamento de óleo no Nordeste. Brasília, DF: Ministério da Saúde; 2019.. This would allow for identifying, assessing, and monitoring potential disaster occurrences to implement preventive measures and early warning systems¹³13 Organização Pan-Americana da Saúde; Ministério da Saúde. Desastres Naturais e Saúde no Brasil [Internet]. Brasília, DF: Opas, Ministério da Saúde; 2014 [acesso em 2021 ago 26]. Disponível em: https://iris.paho.org/handle/10665.2/7678
https://iris.paho.org/handle/10665.2/767... ,¹⁴14 Ministério da Saúde (BR), Fundação Nacional da Saúde. Protocolo de atuação da Funasa em situações de desastres [Internet]. Brasília, DF: Funasa; 2018 [acesso em 2021 ago 26]. Disponível em: http://www.funasa.gov.br/documents/20182/38937/PROTOCOLO_Atuacao_Desastres_2018+WEB.pdf
http://www.funasa.gov.br/documents/20182... ,¹⁵15 Shoaf K. Organizando o setor saúde para responder a desastres. Ciênc saúde coletiva. 2014;19(9):3705-15. DOI: https://doi.org/10.1590/141381232014199.03722014
https://doi.org/10.1590/141381232014199.... ,¹⁶16 Santos RC, Gurgel AM, Silva LIM, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,¹⁷17 Lefevre F, Lefevre AMC, Marques MCC. Discurso do sujeito coletivo, complexidade e auto-organização. Ciênc saúde coletiva. 2009;14(4):1193-1203. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,¹⁸18 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos e revoga as Resoluções CNS nos. 196/96, 303/2000 e 404/2008. Diário Oficial da União [Internet], Brasília, DF. 2013 jun 13 [acesso em 2023 ago 2]; Seção I:549. Disponível em: https://cep.ensp.fiocruz.br/sites/default/files/res_466J012.pdf
https://cep.ensp.fiocruz.br/sites/defaul... ,¹⁹19 Ministério da Saúde (BR); Conselho Nacional de Saúde. Resolução nº 510, de 7 de abril de 2016. Dispõe sobre as normas aplicáveis a pesquisas em Ciências Humanas e Sociais cujos procedimentos metodológicos envolvam a utilização de dados diretamente obtidos com os participantes ou de informações identificáveis ou que possam acarretar riscos maiores do que os existentes na vida cotidiana. Diário Oficial da União [Internet], Brasília, DF. 2016 maio 24 [acesso em 2023 ago 2]; Seção I:44. Disponível em: https://conselho.saude.gov.br/images/comissoes/conep/documentos/NORMAS-RESOLUCOES/Resoluo_n_510_-_2016_-_Cincias_Humanas_e_Sociais.pdf
https://conselho.saude.gov.br/images/com... ,²⁰20 Silva LRC, Pessoa VM, Carneiro FF, et al. Derramamento de petróleo no litoral brasileiro: (in)visibilidade de saberes e descaso com a vida de marisqueiras. Ciênc saúde coletiva. 2009;14(4):1193-204. DOI: https://doi.org/10.1590/S1413-81232009000400025
https://doi.org/10.1590/S1413-8123200900... ,²¹21 Silva LIM, Antunes MBC, Albuquerque MSV, et al. O derramamento de petróleo no litoral pernambucano a partir das narrativas do Jornal do Commercio. Rev Eletron Comun Inf Inov Saúde. 2022;16(4):913-925. DOI: https://doi.org/10.29397/reciis.v16i4.3279
https://doi.org/10.29397/reciis.v16i4.32... ,²²22 Richetti GP, Milaré P. O Óleo no Nordeste Brasileiro: Aspectos da (an)alfabetização Científica e Tecnológica. RBPEC. Brasileira de Pesquisa em Educação em Ciências. 2021; (e29065):1-29. DOI: https://doi.org/10.28976/1984-2686rbpec2021u11871215
https://doi.org/10.28976/1984-2686rbpec2... ,²³23 Centro Brasileiro de Estudos de Saúde. Pela Declaração de Estado de Emergência em Saúde Pública para Controle dos Riscos Decorrentes da Maior Tragédia de Contaminação pelo Petróleo na Costa do Brasil | UFBA. Cebes [Internet]. 2019 out 28 [acesso em 2021 ago 26]. Disponível em: http://cebes.org.br/2019/10/pela-declaracao-de-estado-de-emergencia-em-saude-publica-para-controle-dos-riscos-decorrentes-da-maior-tragedia-de-contaminacao-pelo-petro-leo-na-costa-do-brasil-ufba/
http://cebes.org.br/2019/10/pela-declara... ,²⁴24 Aguilera F, Mendez J, Pasaro E, et al. Review on the effects of exposure to spilled oils on human health. J Appl Toxicol. 2010;30(4):291-301. DOI: https://doi.org/10.1002/jat.1521
https://doi.org/10.1002/jat.1521... ,²⁵25 Euzebio C, Rangel G, Marques R. Derramamento de Petróleo e seus impactos no ambiente e na saúde humana. RBCIAMB. 2019;(52):79-98. DOI: https://doi.org/10.5327/Z2176-947820190472
https://doi.org/10.5327/Z2176-9478201904... ,²⁶26 Rung AL, Gaston S, Oral E, et al. Depression, mental distress, and domestic conflict among Louisiana women exposed to the deepwater horizon oil spill in the watch study. Environ Health Perspect. 2016;124(9):1429-1435. DOI: https://doi.org/10.1289/ehp167
https://doi.org/10.1289/ehp167... ,²⁷27 Birkland TA, DeYoungy SE. Emergency response, doctrinal confusion, and federalism in the deepwater horizon oil spill. J Federalism. 2011;41(3):471-493. DOI: https://doi.org/10.1093/publius/pjr011
https://doi.org/10.1093/publius/pjr011... ,²⁸28 Santos RC, Gurgel AM, Silva LLM, Santos L, et al. Desastres com petróleo e ações governamentais ante os impactos socioambientais e na saúde: scoping review. Saúde debate. 2022;46(esp8):201-220. DOI: https://doi.org/10.1590/0103-11042022E815
https://doi.org/10.1590/0103-11042022E81... ,²⁹29 Hur JY. Disaster management from the perspective of governance: case study of the Hebei Spirit oil spill. Disast. Prevent. Manag. 2012;21(3):288-298. DOI: https://doi.org/10.1108/09653561211234471
https://doi.org/10.1108/0965356121123447... ,³⁰30 United Nations, Secretary-General for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2015 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/files/43291_sendaiframeworkfordrren.pdf
https://www.preventionweb.net/files/4329... ,³¹31 Oliveira M. Manual gerenciamento de desastres: sistema de comando de operações [Internet]. Florianópolis: Ministério da Integração Nacional, Secretaria Nacional de Defesa Civil; 2009 [acesso em 2022 ago 20]. Disponível em: https://www.ceped.ufsc.br/wp-content/uploads/2014/09/Manual-de-Gerenciamento-de-Desastres.pdf
https://www.ceped.ufsc.br/wp-content/upl... ,³²32 Rêgo RF, Müller JS, Falcão IR, et al. Vigilância em saúde do trabalhador da pesca artesanal na Baía de Todos os Santos: da invisibilidade à proposição de políticas públicas para o Sistema Único de Saúde (SUS). Rev Bras Saúde Ocup. 2018;43:e10s. DOI: https://doi.org/10.1590/2317-6369000003618
https://doi.org/10.1590/2317-63690000036... ,³³33 Kelmo F. Efeito das manchas de óleo sobre as comunidades bentônicas recifais. O que podemos tirar após 08 meses de derramamento de óleo no litoral nordestino? In: Universidade Federal da Bahia. Congresso virtual UFBA 2020 [Internet]. [local desconhecido]; UFBA; 2020 maio 27 [acesso em 2022 ago 20]. Disponível em: https://www.youtube.com/watch?v=aAah-u-Sdp4c
https://www.youtube.com/watch?v=aAah-u-S... ,³⁴34 Silva DCP, Melo CS, Oliveira AB, et al. Derramamento de óleo no mar e implicações tóxicas da exposição aos compostos químicos do petróleo. Rev Cont Saúde. 2022;21(44):332-344. DOI: https://doi.org/10.21527/2176-7114.2021.44.11470
https://doi.org/10.21527/2176-7114.2021.... ,³⁵35 Secretaria da Saúde do Estado (BA). Protocolo de avaliação da saúde de população exposta a petróleo: orientações para serviços e trabalhadores da saúde da Bahia [Internet]. Salvador: Sesab; 2021 [acesso em 2022 ago 20]. Disponível em: https://www.saude.ba.gov.br/wp-content/uploads/2021/11/Protocolo-Petroleo_4nov2021-1.pdf
https://www.saude.ba.gov.br/wp-content/u... ,³⁶36 Organização das Nações Unidas, Estratégia Internacional para a Redução de Desastres. Marco de Ação de Hyogo 2005-2015: aumento da resiliência das nações e das comunidades frente aos desastres [Internet]. Genebra: ONU; 2005 [acesso em 2022 ago 20]. Disponível em: https://educacao.cemaden.gov.br/midiateca/marco-de-acao-de-hyogo-2005-2015aumento-da-resiliencia-das-nacoes-e-das-comunidades-frente-aos-desastres/
https://educacao.cemaden.gov.br/midiatec... .

Maintaining a process of reviewing and updating the ERPs for disasters, taking into account the dynamics of the territory, the organization of health services, and the training of professionals, among other elements, is fundamental to dealing with the occurrence of disasters⁴²42 United Nations; United Nations International Strategy for Disaster Reduction. Bangkok principles for the implementation of the health aspects of the Sendai framework for disaster risk reduction 2015-2030 [Internet]. [Geneva]: The United Office for Disaster Risk Reduction; 2016 [acesso em 2022 ago 20]. Disponível em: https://www.preventionweb.net/publication/bangkok-principles-implementation-health-aspects-sendai-framework-disaster-risk
https://www.preventionweb.net/publicatio... .

Final considerations

The disaster crime demanded significant efforts from authorities and relevant agencies to mitigate the environmental and public health impacts on the affected population. The results highlighted significant weaknesses in health management, including the lack of prior organization and planning and the absence of teams equipped to handle such situations in most management agencies across all three levels of government, resulting in an inability to prevent further harm.

Another issue identified was the weakness of social protection measures, particularly the implementation of socio-economic policies. Given that the most affected population (artisanal fishers) lost their means of livelihood and that many did not receive the financial assistance provided by the federal government, some municipalities offered basic food baskets. However, these were insufficient to meet the needs of these families.

Actions aimed at preventing, mitigating, and managing damage resulting from these events do not depend solely on health management but must be joint actions with other sectors/segments and services, such as environmental agencies, civil defense, social action secretariats, and organized civil society itself. Local communication services are essential in disasters, as they enable the dissemination of information to the population and issue early warnings, which can prevent risky situations.

Given the scarcity of such documents, each federated entity needs to draw up an ERP for oil-related disasters. These plans should cover all phases of disaster management to help manage and prevent this type of disaster, from the risk management phase — to prevent the occurrence of the adverse event — to the recovery and resilience phase of the affected areas.

References

Publication Dates

History