We are IntechOpen,

the world’s leading publisher of

Open Access books
Built by scientists, for scientists

4,900
Open access books available
124,000
International authors and editors
140M Downloads

Our authors are among the

154
Countries delivered to
TOP 1%
most cited scientists
12.2%
Contributors from top 500 universities

Selection of our books indexed in the Book Citation Index

in Web of Science™ Core Collection (BKCI)

Interested in publishing with us?

Contact book.department@intechopen.com
Numbers displayed above are based on latest data collected.
For more information visit www.intechopen.com
Chapter

Role of Primary Health Care

System in Response to a Major
Incident: Challenges and Actions
Abdulnasir Falah Huaidi Al-Jazairi

Abstract

There is obvious increase in world population and in term of number of major

incidents (MI) all over the world, there is a need for faster and wider responses. To
achieve this aim and keep losses to the minimum, we need to optimize our methods
and protocols of the response to decrease the losses, pain, and suffering of people and
losses of infrastructures, belongings, and the country’s future. Primary health care
(PHC) system, which is present in all residency gatherings in cities and towns, pro-
vides suitable potential for this improvement. This role has been formulated in 1978 in
Alma-Ata meeting, which changes the scope of service of primary health care system
to take responsibility of the community in addition to patients’ care. The involvement
of the primary health care in response to major incidents shows good results, and there
is a need to strengthen the major incidents’ response plan in the primary health care to
provide better response and help to all populations especially the vulnerable ones.

Keywords: primary health care, major incidents, vulnerable population, planning,

response, recovery

1. Introduction

There is a noticeable increase in major incidents (MI) of different types affecting

the world in the last three decades with increased human and financial losses. There
are different types of incidents: natural, man-made, and infectious epidemics. For
optimum response to those incidents, there should be multidisciplinary coordinated
teams’ response [1].
Shortly after I started writing this chapter, the COVID-19 epidemic in China
expanded to be a pandemic, affecting too many countries and hundreds of thou-
sands of people and killing more than 50,000 all over the world. This has a clear
effect on my chapter to concentrate on this type of major incidents.
Primary health care (PHC) system scope of service was concentrated on disease
consultations and prescription of medication. This scope had been changed in
1978 by the Declaration of Alma-Ata, which considered health care as fundamental
human right. Section V in the declaration stated clearly that the primary health care
system is the key to achieve the targets of the declaration. This declaration leads
to the change of the scope of work of the PHC from giving advice about patients’
symptoms to the comprehensive health care of the community [2]. This aim of
comprehensive health care of the PHC was reviewed in WHO report in 2008 [3],
which centered on taking the PHC service from hospitals and specialized centers to

1
Primary Care

be nearby people in general walk-in clinics that are easily reached by community.
This proved to have many benefits in:

• Relief suffering

• Prevention of illness and death

• Improved health equity

The PHC system, with its distribution in all areas to be near to large population,
can play an important role in response to any MI affecting its catchment area. The
PHC staff have better knowledge in their area population and the special needs
categories. Those abilities enable the PHC system to play a crucial role in response to
major incidents in all their stages.

2. Definitions

2.1 Primary health care system

PHC is a whole-of-society approach to health that aims to ensure the highest

possible level of health and well-being and their equitable distribution by focusing
on people’s needs and preferences (as individuals, families, and communities) as
early as possible along the continuum from health promotion and disease preven-
tion to treatment, rehabilitation, and palliative care and as close as feasible to
people’s everyday environment [4].

2.2 Comprehensive health care

“The practice of continuing comprehensive care is the concurrent prevention

and management of multiple physical and emotional health problems of a patient
over a period of time in relationship to family, life events and environment” [5].

2.3 Major incident

In health care system, “A major incident can be defined as any incident where
the location, number, severity or type of live casualties requires extraordinary
resources” [6].

2.4 Vulnerable populations

Vulnerable populations include patients who are racial or ethnic minorities,

children, elderly, socioeconomically disadvantaged, underinsured, or those with
certain medical conditions. Members of vulnerable populations often have health
conditions that are exacerbated by unnecessarily inadequate health care [7].

3. Factors that make PHC suitable to play an essential role in

response to MI

• Work concept: Changing to comprehensive health care of the community

makes the PHC responsible to prepare people to a disaster if there is time to
and help them during its occurrence and in the post-incident stage.

2
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

• Community based: The responsibility is for the welfare of the whole commu-
nity and not for medical advice when asked only.

• Easy accessibility: The presence of PHC centers in close proximity to people

makes them reachable with little efforts. During a major incident, there are
many things people are busy with, or some have lost helpers; the presence
of a nearby health care facility will decrease patients and people suffering in
attending and getting the proper health advice they need.

• Dealing with all types of diseases: The PHC centers are run by family medi-
cine physicians (FP) or general practitioners (GP), and they are trained to deal
with all types of diseases and possess the ability to deal with all patients or
persons asking different types of consultations in many specialties.

• Filtering ability: The doctors in primary care are trained to deal with patients
in all specialties. This practice gives them the ability to work in the early step
of sorting cases. PHC can deal with simple cases that constitute 50 to 60% of
cases and keep hospitals and specialized centers for more severe cases.

• Decrease cost: FP/GP use less tools and request less investigations for their
work, and this cuts the cost the patient should pay for care. This is exaggerated
during major incident circumstances, which enable the health system to deal
with larger number of patients in the same cost if the patients have been man-
aged by hospitals only.

Stages of major incidents: Most of the researchers divide the major incidents
into four stages:

A. Mitigation and prevention

B. Preparedness

C. Response

D. Recovery

Although this has many positive implications, Quarantelli in 1980 [8] put major
incident phases depending on the time factor. He put three phases as follows:

I. Pre-impact phase

II. Trans-impact phase

III. Post-impact phase

In the coming sections, I will discuss the role of the PHC system according to the
phase and regarding the staff, space, stuff, and communication roles. The discus-
sion will be divided into two parts as follows:

A. Effect of major incident on primary health care. This will be under the title
“Challenges.”

B. Actions by the primary health care in response. This will be under the title
“Actions.”

3
Primary Care

4. Pre-impact phase

PHC system is the nearest health facility to most people and is easily accessible;
therefore, it is, mostly, the first place that the patients will attend to get information
and advice for their conditions and worries about any new threat or risk.

4.1 Challenges

The challenges will affect PHC staff and PHC facility. The challenges will
depend on the risks more suspected in the geographical area in which the health
facility is present.

4.1.1 PHC staff

a. The PHC staff are holding double personality during major incidents; from one
side they are part of families and they have responsibilities for them, and on
the other side, they have commitment to work to help people and other com-
munity services.

b. The staff will be under pressure to have answers to the new threat and its
relations to the different diseases and medications.

c. Dealing with major incidents is not part of day-to-day activity of the health
sector; therefore, there is lack of knowledge of the major incident response
plan (MIRP) to the facility and their specific roles. All staff in the PHC in all
levels whether clinical or nonclinical should have specific training on the MIRP
and their specific role in it, so everybody will speak the same language during
the response and can harmonize work better.

d.Psychiatric aspect of the major incident will affect both PHC staff and people
visiting the health facility. Staff should have basic training to deal with those
difficult situations.

4.1.2 PHC facility

a. There will be an increase in visits to PHC from people for different consulta-
tions, which will lead to overcrowding in the PHC.

b. More medications and stuff are requested by patients to have stocks during the
expected incidents. This will impose pressure on the stocks of the medications
and consumable stuffs.

c. How to change the layout of the facility to accommodate more visitors if

needed? This is depending on the blue print of the facility and whether it is
manageable or not.

d.Is the facility in danger of the incident or not? This is more applicable in the
natural disasters like earthquake, tornados, and hurricanes. What to do if it is
affected and cannot provide service?

e. The infrastructures like electricity, water, or network may be affected

by the incident. What are the substitutes or mitigation solutions for this
breakdown?

4
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

4.2 Actions

The period before expected incidents is a suitable situation to do improvements

in planning, training for staff, and stockpiling stuff. PHC administrators need to
achieve the following aims:

a. Orient the local and national health system on the PHC active involvement in
protecting community, and strengthen the skills of risk management in the
PHC directors.

b. Concentrate on efforts to support communities, individuals, and health

workers to better respond to major incidents. This is done by providing enough
information about the disease and protective measures, vaccinations, and
actions to do if any family member or oneself is affected.

c. Financial investment in the infrastructures of the PHC regarding water,

electricity, information, communications, and supply network.

The abovementioned aims will be accomplished through the following:

4.3 Planning

PHC should work in close collaboration with local health authority and other
emergency services in developing response plans.
They should look to the following issues:

1. Define hazards and risk factors to the area, in collaboration with other emer-
gency services. This will help in predicting expected incidents and their effects
on the health of the community they are serving. Also, it will help in preparing
the type of medications and consumables.

2. Make lists with addresses of the vulnerable population and those using regular
medications in their area. This will allow the health and other authorities to
prepare shelter, medications, and other care plans during MI.

3. The effect of the expected MI on different diseases should be prepared with

the help of the specialized sections in local, state, or federal (or ministerial)
health authorities. Information should be relayed to the concerned patients
along with best mitigation actions.

4. Setting agreements with ambulance services to transfer patients (who need

hospital transfer) received in PHC during MI.

5. Information regarding any MI expected, its nature, the expected size, and the
need to activate the MI response plan. That critical information should be veri-
fied, i.e., the source of information should be trusted and accurate.

6. Allocate area to be an alternative place, and make pre-arrangement for rapid

conversion into PHC facility if the original building became unsuitable for work.

4.4 Training staff

Staff should have training on several aspects of MI response including the

needed information to help the community and individuals.

5
Primary Care

This includes the following:

1. Training the staff on the MI response plan set for the area. The response plan
should be flexible to meet the different types and effects of different incidents.
The plan should rhyme with the local and state health response plan.

2. Training the staff on communication with people including agitated and aggres-
sive people. Communication training should include breaking bad news. They
may have to visit families and inform them about their relatives, good or bad news.

3. Training on working in austere conditions in case there is damage to the

infrastructure of the PHC facility and a need to work in small or large teams
depending on the incident circumstances and decision of the local authority or
state’s incident response leaders.

4. Training on more than one method of communication including radio com-

munication protocols. Radio communication will be used if other methods are
lost by the effect of the incident.

4.5 Prepare for infrastructure failure

a. Electricity failure is one of the major failures during MI. It has serious negative
effects on patients’ care. Electricity generator working on petrol should be
prepared and maintained regularly to be ready anytime electricity cut occurs.

b. Water loss. Large water reservoir should be ready, and the water should be
replaced on a daily basis. In addition, drinking water bottles should be part of
stockpiling in preparation to a major incident. Potable drinking water in addi-
tion to clean water suitable for different uses in the facility and patients’ care is
crucial for work in any place and especially in PHC.

c. Communications: It is important to have at least two ways to contact the staff.

If one method failed, the other will be the backup. A third wireless radio com-
munication should be prepared for extreme loss of any sort of communication.

d.Network: Failure of network can occur alone or accompanying electricity

failure. Server backup should be applied to keep the important information
regarding patient, administrative, pharmacy, and store documents.

4.6 Stockpile stuff

During daily work, the PHC centers are stocking their expected needs of drugs
and consumables for a certain period depending on the chain of supply. If there is
a risk or threat of any type that needs special medications or protective equipment,
the PHC centers should bring these stocks according to the population supported
with the coordination of the local or national health authority.

5. Trans-impact phase

As mentioned above, the PHC will be the first point people will reach to seek
help and advice regarding injuries or information regarding an epidemic infection.
This includes many challenges.

6
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

5.1 Challenges

The WHO in their briefing about PHC and emergencies [9] mentioned some of
the challenges as follows:

1. Without earlier warning system, case identification and escalation are a chal-
lenge that PHC staff face. Most epidemics usually start as patients come to seek
medical advice, which is a day-to-day work in PHC. Case definition and raising
the suspicion of a disease that may be an early epidemic or even pandemic (like
the COVID-19) need to be reported to more central and higher authority with
experts in epidemiology and infectious diseases.

2. Geographical accessibility:

a. Several types of natural disasters like earthquake, floods, etc. may affect
the PHC and its surrounding area, preventing health workers, people,
or supply chain from reaching it. This will render the PHC useless, and
alternative methods should be placed to mitigate this challenge.

b. In the same context, geographical accessibility to patients and survivals

will be sometimes difficult if not impossible and need special help.

c. People with special need will face more difficulty in major incidents in
accessing the PHC. The rescuers will face more difficulty in moving people
with special needs in case there is need for it.

d.Transferring patients and staff to an alternative place or transferring

patients to hospital may be a challenge in certain circumstances.

3. Skillful health workers are part of the community and may be affected by the
incidents either themselves or their families, and in both situations, they can-
not be available to treat and help people. PHC may replace them by less skilled
staff which will affect the care in this difficult situation.

4. Health facility infrastructure may be affected by the incident, and loss of

water, electricity, and network supply, for example, will also affect the ability
of PHC to offer help and services.

5. The incidents may affect the chain of supply, leading to a decrease in resources
and limitations in the numbers and types of medications and services available.

6. If there is an incident that is big enough to affect large cities and states, the
government will distribute the funds and resources to all areas. This mostly
will make the amount given to a certain PHC center below its actual needs.
This has effects on the availability of staff and supplements and decreases in
the PHC center’s effective services.

7. Ensuring quality of care to be in acceptable level. In day-to-day work, the

quality should be in the optimum; this is not applicable in most MI, but there
should be an agreed acceptable level of quality during major incident, so the
PHC centers do not go below it. This is extremely important to decrease the
spread of infectious diseases that follow major incidents and decrease mortal-
ity and morbidity for all patients.

7
Primary Care

5.2 Actions

There are many actions needed during the response phase. Those actions are
classified according to the condition of the facility.

A. Health facility is intact, accessible, and functioning:

1. Activate the major incident response plan. This is the decision taken by
PHC facility leader in liaison with the local and state health authority.

2. Change the layout of the facility and the patients’ flow to permit faster
management of patients with acceptable standards.

3. Call the staff who are in their off or vacation to join work in the facility to
deal with the increased numbers of patients and visitors.

4. Stop elective visits of patients, and replace it by telephone or online con-

sultations. If there is a need to see the patient and examine him physically,
then go to him/her or call the patient to the center; examine the patient
in area away from the incident management venue. This will decrease the
number of patients attending to the health center and create surge capacity
to examine patients related to the major incidents.

5. Contact local health authority and nearby hospitals to liaise about the
situation and work distribution. The PHC can have an important role in
dealing with the well and worried people and patients with mild symptoms
to decrease the load on hospitals and minimize people’s need for trans-
portation. The movement restriction is an important factor in controlling
epidemics and makes movement of emergency services easy and fast.

6. Make special documentation for the incident patients and other related is-
sues like questionnaires, asking about relatives, etc. This will help in better
preparedness for future incidents.

7. PHC director and supervisors should observe staff for signs of PTSD. Daily
debriefing session should be done by the end of the shift. The management
of PTSD staff will depend on the severity of symptoms.

a. Mild PTSD usually is solved by the support of colleagues and the daily
debriefing session.

b. They may change the type or place of work of the staff if they noticed
moderate symptoms of PTSD.

c. Staff with severe symptoms of PTSD should be stopped from dealing

with patients, and psychologist or psychiatrist consultation is requested.

B. If the primary health facility is not accessible or not functioning:

1. The alternative site should be activated, and directional signs to the new
site, people, and authorities should be informed about the new site.

2. Medical teams [10, 11].

8
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

The concept of emergency medical teams applied in disaster management is well

known worldwide and applied by the WHO and other bodies interested in disaster
response. We can apply this concept to distribute the primary health staff into small
teams and direct them (as forward teams) to different residential areas in conjunc-
tion with other emergency services. Their duty is to:

a. Define the special needs and vulnerable population.

b. Supply chronic medications to the needed.

c. Defining affected people and do baseline life support interventions.

d.Contact health authority or hospitals for patients who need to transfer to higher
level of health care.

e. This concept, going to patients in their residency, can be used even if the facil-
ity is accessible and functioning. It is an extra service for people in catchment
area aiming to bring health care very near to people and help in stopping the
spread of epidemic infections.

C. Start thinking of recovery for the health centers during a long-lasting major
incident, for example, the COVID-19 pandemic, which is affecting the whole
world now. There should be regular thinking of how to resume work in the
PHC to serve the patients who need regular follow-up. This can be done by
telephone or network meeting (as mentioned above), and medications can be
delivered to the patient at their homes through the post. Fees can be paid by
electronic payment methods.

D. Live experience on the role of PHC in epidemic.

During the writing of this chapter, there is a COVID-19 epidemic. In the begin-
ning of the epidemic, many people came to the emergency department asking for
checkup and PCR test for COVID-19. This issue created overcrowding in emergency
departments all over the country, and many people present are requesting the test.
This was dangerous for spreading the infection if someone is really infected. Two
days later, the PHC sets up centers for dealing with well and worried persons and
provided COVID-19 PCR test. This action by the PHC did a huge decompression
to emergency departments, decreased mix between well and feverish persons, and
gave us opportunity to concentrate on symptomatic patients.

6. Post-impact phase

Recovery from the effects of the MI occurs in this phase. Sometimes, when the
MI takes long time, the PHC should resume receiving patients other than MI. There
is merging between trans-impact and post-impact phases. Recovery of the PHC will
be better if it was part of the pre-incident plan [12].

6.1 Challenges

1. Many times, there are epidemics after major incidents especially if the incident af-
fected the infrastructures of basic services like potable water and electricity. This
effect is aggravated if people need to migrate from their area for any reason and

9
Primary Care

assemble in a new area, which is usually less suitable and overcrowded. This per-
mits for disease transmission creating an epidemic between the migrants. Acute
respiratory infections and cholera are among the most epidemics that occur in im-
migrants [13]. Some of these diseases are not present in the PHC area previously.

2. New patients may be added to the PHC from two sources:

a. In the first source, there is an epidemic in the area covered by the PHC after
the major incident. More patients are presented to PHC for consultations.

b. The second source is the new people who moved to their area from other
places, which rendered unsuitable for living (temporarily or permanently)
by the major incident.

3. New diseases may occur due to loss of infrastructure and sanitation or due to
earth changes, leading to bacterial, fungal, and other infectious organisms that
are not common in the area. It is found in one study that there was an increase
in visits for patients complaining of respiratory symptoms (mostly asthma)
and diabetes [14].

4. In the last 40 years, all the studies showed that there is a significant increase in
stress levels of both health care staffs and patients in post-major incident phase
[15]. This will decrease the working staff on the one hand and increase the
patients visiting the PHC on the other hand.

5. Delayed appointments for patients already registered in the PHC due to MI re-
sponse actions. After the end of the incident, work need to be back to normal,
and the patients whom appointments were postponed in the response period
need to be rescheduled in addition to the regular appointments and providing
appointments to the new patients.

6. Gathering information and statistics about the MI and its effects on the PHC
in all aspects. Information regarding response to the major incidents, pa-
tients’ flow, number of patients, types of complaints, areas of crowding and de-
lay, etc. all need to be collected, summarized, studied, and used in this phase to
prepare the PHC for improved response in the next major incident.

7. Funding. During the trans-impact phase, the media concentrate on every ac-
tivity done by all emergency services. This media coverage is a good motivation
for providing funds by governments, nongovernmental organizations, and
personnel. In the post-impact phase, this media coverage will decrease a lot
especially if there is another major incident in other parts of the world.

6.2 Actions

This stage is an opportunity to improve the PHC and rebuild it better than
before, by applying risk reduction and optimizing work protocols [16]. The actions
in the post-impact phase can be divided into three stages [17]:

a. Early recovery stage

In this stage there is emphasis on clinical services; the PHC is trying to go back
actively again. It is trying to open its services to people if the facility was closed

10
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

during the incident’s response phase or increase work if it was working in

limited scope during the previous phase. The following are the steps to do this
objective:

1. Maintain the PHC building, especially if it is affected by the incident. If

there was an epidemic, then there is a need to deep cleaning and steriliza-
tion before allowing entrance and providing service to usual patients.

2. Debriefing to staff after the trans-impact phase. This may need psycholo-
gist or psychiatrist sometimes. The PHC director should evaluate the staff
during all the phases. In this phase there is time to deal with the staff who
shows mild-to-moderate PTSD.

3. Rearrange duty roasters for staff in a way that they can work and have time
to look after their families.

4. Education to staff regarding new diseases that occurs in the post-impact

phase. This should be arranged with local health authority and hospitals.
There will be many questions regarding the new disease and relations to
the chronic diseases they have.

b. Rehabilitation stage

The aim of this stage is to reach the pre-impact stage level of work and go back
to normal activity or put a new norm to help in better response in the future.
Activities in this stage are the following:

1. Maintain used equipment and fix the damaged ones. Electricity genera-
tors, water tanks, and ultrasound machines all should be checked by
specialized teams.

2. Refill stores with medicines and consumables. When there is MI, there is
large number of patients which is more than the present resources. After the
end of the trans-impact phase, stores should be rearranged to have enough
supply of the previous drugs and stuff for the new emerging diseases.

3. Rearrange patients’ visits to decrease delay, and catch the condition before
the incident.

4. Make appointments for the new patients added to the PHC facility after
the impact. This may need recruitment of new staff to accommodate those
patients in addition to the delayed patients mentioned in the previous
point.

5. If an alternative place has been used and proven to be better than the origi-
nal one, try using it permanently. All actions, official documentations, and
addresses should be changed to the new place.

c. Development stage

This is a long-term stage, and its aim is to prepare the PHC for the next major
incident. It will be mixed with the mitigation and preparedness stages in the
pre-impact phase. To achieve this stage properly, there is a need to:

11
Primary Care

1. Collect data through statistics regarding different aspects of the incident,

for example, numbers, diagnosis, age, etc.

2. Make plans for better facility; this may need change or an increase in
facility building. Make plans to divide the facility into sectors if needed to
maintain isolation for containing infections and easy sterilization of the
parts of the facility. This should include the ventilation system of different
areas.

3. Improve communication plan to the staff. All staff should have their
contact addresses including the social media addresses and landlines if
present.

4. Arrange with the local health authority to have any specific PHC plan to be
part of a master plan and any PHC capabilities to add to the total state or
national health abilities, and there is no need for doubling the work.

5. Fund raising should be started and requested from the local and state
health authority to do all these changes in the facility and train the staff on
different aspects of the MI response.

7. Conclusion

The primary health care system has big and important roles that can be played in
response to major incidents. They are the most nearby health care facility and well
known to people in each area, making it the nearest health facility that is ready to
provide help when people are exposed to a sudden incident.
Their role is not limited to any stage in the incident, but it is in all phases. In
some aspects of response, the primary health care staff will guide the state or
national efforts to find and help vulnerable population in their catchment area.
More concentration on the primary health care system in terms of staff training,
facility floor plans, and stuff stockpiling will yield a remarkable improvement in
response to any major incidents.

12
Role of Primary Health Care System in Response to a Major Incident: Challenges and Actions
DOI: http://dx.doi.org/10.5772/intechopen.92461

Author details

Abdulnasir Falah Huaidi Al-Jazairi

FRCS (Glasgow), MScDM, Hamad Medical Corporation, Qatar

*Address all correspondence to: ahuaidi@hamad.qa

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

13
Primary Care

References

[1] Ray K, Ghimire J, Bc RK. Effects of fmt_guidelines_september2013.pdf

disaster on primary health care in low [Accessed: 26 March 2020]
income countries. Journal of Nepal
Health Research Council. 2019;17(1): [11] Reis ND, Dolev E. Manual of
1-8. DOI: 10.33314/jnhrc.1688 Disaster Medicine: Civilian and Military.
Berlin: Springer-Verlag; 1989 [Accessed:
[2] Park S, Abrams R. Alma-Ata 40th 27 March 2020]
birthday celebrations and the Astana
declaration on primary health care 2018. [12] Cometto G, Fritsche G, Sondorp E.
The British Journal of General Practice. Health sector recovery in early post-
2019;69(682):220-221 conflict environments: Experience
from southern Sudan. Disasters.
[3] Sheiham A. Closing the gap in a 2010;34(4):885-909 [Accessed: 27
generation: Health equity through March 2020]
action on the social determinants
of health. A report of the WHO [13] Watson JT, Gayer M,
Commission on social determinants Connolly MA. Epidemics after natural
of health (CSDH) 2008. Community disasters. Emerging Infectious
Dental Health. 2009;26(1):2-3 Diseases. 2007;13(1):1-5. DOI: 10.3201/
eid1301.060779 [Accessed: 28 March
[4] World Health Organization. Primary 2020]
health care. 2019. Available from:
https://www.who.int/news-room/ [14] Chowdhury MAB, Fiore AJ,
fact-sheets/detail/primary-health-care Cohen SA, et al. Health impact of
[Accessed: 28 February 2020] hurricanes Irma and Maria on St
Thomas and St John, US Virgin Islands,
[5] Comprehensive Care, Definition of 2017-2018. American Journal of Public
AAFP. Available from: https://www.aafp. Health. 2019;109(12):1725-1732. DOI:
org/about/policies/all/care-definition. 10.2105/AJPH.2019.305310 [Accessed:
html [Accessed: 22 March 2020] 28 March 2020]

[6] Available from: http://www.mimms. [15] Galea S, Nandi A, Vlahov D. The

org.au/major-incidents [Accessed: epidemiology of post-traumatic stress
22 March 2020] disorder after disasters. Epidemiologic
Reviews. 2005;27(1):78-91. DOI:
[7] Waisel DB. Vulnerable populations 10.1093/epirev/mxi003 [Accessed:
in healthcare. Current Opinion in 28 March 2020]
Anaesthesiology. 2013;26(2):186-192
[16] Mortlock A, Vasconez AC, Bittner P,
[8] Rodriguez H, Quarantelli EL, Alatrista CB, Matsuoka Y. Disaster
Dynes RR. Handbook of Disaster Recovery Guidance Series: Health
Research. Switzerland: Springer; 2007 Sector Recovery - World. ReliefWeb.
2017. Available from: https://reliefweb.
[9] “Primary Health care and int/report/world/disaster-recovery-
Health Emergencies.” World Health guidance-series-health-sector-recovery
Organization. Available from: [Accessed: 27 March 2020]
https://apps.who.int/iris/rest/
bitstreams/1251548/retrieve [Accessed: [17] Al-Jazairi A. Disasters and disaster
24 March 2020] medicine. In: Alsheikhly AS, editor.
Essentials of Accident and Emergency
[10] Norton I, et al. Available Medicine. UK: BoD – Books on Demand;
from: Www.who.int, www.who. 2019. pp. 111-112. DOI: 10.5772/
int/hac/global_health_cluster/ intechopen.71634
14