Global & Disaster Medicine

Archive for the ‘Historical’ Category

9/18/1987: Cesium-137 is removed from an abandoned cancer-therapy machine in Goiana, Brazil and hundreds of people were eventually poisoned by radiation from the substance

History Channel


9/16/1978: A 7.7M earthquake lambasts Iran, killing more than 25,000.

History Channel


9/16/2013: a 34-year-old man goes on a rampage at the Navy Yard in Washington, D.C., killing 12 people and wounding several others over the course of 1 hour before he is killed.

History Channel


GAO: Initial Observations on the Federal Response and Key Recovery Challenges to the Hurricanes and Wildfires of 2017


2017 Hurricanes and Wildfires:

Initial Observations on the Federal Response and Key Recovery Challenges

GAO-18-472: Published: Sep 4, 2018. Publicly Released: Sep 4, 2018.


Federal and state preparedness and coordination efforts prior to and after the 2017 hurricane and wildfire disasters facilitated the response in Texas, Florida, and California. Specifically, the Federal Emergency Management Agency (FEMA) and state emergency management officials implemented various preparedness actions prior to landfall of the hurricanes and during the wildfires—such as predeploying federal personnel to support response efforts; colocating federal, state, and local emergency managers; and pre-staging and delivery of commodities like food and water. Further, according to FEMA and state officials, preexisting coordination mechanisms and relationships also facilitated response efforts in each state. For example, FEMA and each state had conducted numerous emergency exercises in the years prior to these disasters and had developed relationships during response to prior disasters that led to accelerated decision-making during the 2017 disasters. Federal and state officials emphasized that there were certainly unprecedented challenges during these disasters—such as deploying a sufficient and adequately-trained FEMA disaster workforce—and lessons learned, but prior response coordination efforts helped to quickly and effectively resolve many of these challenges.

The federal government provided significant support to Puerto Rico and the U.S. Virgin Islands in response to Hurricanes Irma and Maria, but faced numerous challenges that complicated response efforts. FEMA efforts in Puerto Rico alone were the largest and longest single response in the agency’s history. As of April 2018, FEMA had obligated over $12 billion for response and recovery for Hurricane Maria (see figure below) reflecting the scale and complexity of efforts given the widespread damage. FEMA tasked federal agencies with over 1,000 response mission assignments for Hurricanes Maria and Irma in the territories at a cost of over $5 billion, compared to about 400 such assignments for Hurricanes Harvey and Irma and the California wildfires combined. For example, FEMA assigned the U.S. Army Corps of Engineers the mission to install over 1,700 emergency electricity generators in Puerto Rico, compared to the 310 for the response to Hurricane Katrina.

Federal Emergency Management Agency Disaster Relief Fund Obligations and Expenditures for Hurricanes Harvey, Irma, Maria, and California Wildfires through April 30, 2018

Federal Emergency Management Agency Disaster Relief Fund Obligations and Expenditures for Hurricanes Harvey, Irma, Maria, and California Wildfires through April 30, 2018

Note: An obligation is a definite commitment that creates a legal liability of the government for the payment of goods and services ordered or received. An expenditure is an amount paid by federal agencies by cash or cash equivalent, during the fiscal year to liquidate government obligations.

Nevertheless, GAO found that FEMA faced a number of challenges that slowed and complicated its response efforts to Hurricane Maria, particularly in Puerto Rico. Many of these challenges were also highlighted in FEMA’s own 2017 hurricane after action report, including:

  • the sequential and overlapping timing of the three hurricanes—with Maria being the last of the three—caused staffing shortages and required FEMA to shift staff to the territories that were already deployed to other disasters;
  • logistical challenges complicated efforts to deploy federal resources and personnel quickly given the remote distance of both territories; and
  • limited preparedness by the U.S. Virgin Islands and Puerto Rico for a Category 5 hurricane and incapacitation of local response functions due to widespread devastation and loss of power and communications led FEMA to assume response functions that territories would usually perform themselves.

The 2017 hurricanes and wildfires highlighted some longstanding issues and revealed other emerging response and recovery challenges. For example, the concurrent timing and scale of the disaster damages nationwide caused shortages in available debris removal contractors and delays in removing disaster debris—a key first step in recovery. In addition, FEMA’s available workforce was overwhelmed by the response needs. For example, at the height of FEMA workforce deployments in October 2017, 54 percent of staff were serving in a capacity in which they did not hold the title of “Qualified”—according to FEMA’s qualification system standards—a past challenge GAO has identified. FEMA officials noted that staff shortages, and lack of trained personnel with program expertise led to complications in its response efforts, particularly after Hurricane Maria.

Federal Disaster Workforce Deployed at the Height of 2017 Response Acivities

Federal Emergency Management Agency Disaster Relief Fund Obligations and Expenditures for Hurricanes Harvey, Irma, Maria, and California Wildfires through April 30, 2018

Further, federal, state, and local officials faced challenges finding temporary housing for disaster survivors given the extensive damage to available housing in each location. For example, given the widespread damage in Puerto Rico and lack of hotels and other temporary housing, FEMA transported survivors to the mainland United States to stay in hotels. FEMA also used new authorities and procedures to meet the need, such as providing Texas as much as $1 billion to manage its own housing program. However, this approach had not been used or tested in past disasters and state officials noted challenges in managing the program such as staffing shortfalls. State officials further noted challenges in coordinating with FEMA that led to delays in providing assistance to survivors. GAO will continue to monitor these programs.

In 2017, four sequential disasters—hurricanes Harvey, Irma, Maria, and the California wildfires—created an unprecedented demand for federal disaster response and recovery resources. According to FEMA, 2017 included three of the top five costliest hurricanes on record.

The National Oceanic and Atmospheric Administration estimated that the cumulative damages from weather and climate related disasters in the United States were over $300 billion in 2017 alone. As of June 2018, Congress had appropriated over $120 billion in supplemental funding for response and recovery related to the 2017 hurricanes and wildfires. Further, in October 2017, close to 14,000 federal employees were deployed in response to the disasters.

Given the scale and cost of these disasters, Congress and others have raised questions about the federal response and various recovery challenges that have arisen since the disasters. This report provides GAO’s observations on: (1) federal and state preparedness and response coordination for hurricanes Harvey and Irma in Texas and Florida, and the California wildfires; (2) federal preparedness for and response to hurricanes Irma and Maria in Puerto Rico and the U.S. Virgin Islands; and (3) existing and emerging disaster recovery challenges highlighted by these disasters.

GAO analyzed FEMA policies, procedures, guidance, and data specific to disaster response and recovery programs. GAO focused on the busiest period of disaster response activity for the federal government—August 2017 through January 2018, with select updates on recovery efforts and obtained updates through June 2018. In October and November 2017, GAO teams made site visits to hurricane damaged areas in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands. At these locations, GAO visited FEMA joint field operation locations and interviewed FEMA, Department of Defense, and other federal officials about response and recovery operations, visited disaster recovery centers, and observed damage. GAO also interviewed FEMA officials responsible for wildfire response and recovery efforts in California.

Additionally, GAO interviewed state and territorial emergency management officials or their designee in Texas, Florida, California, Puerto Rico, and the U.S. Virgin Islands, as well as officials from eight cities and counties in Texas, Florida, and California (selected based on their proximity to the disaster impacted areas and their availability) to discuss their observations on the federal response in their respective jurisdictions. While the perspectives of these officials are not generalizable, they provided valuable insights into the federal response to the 2017 disasters.

This report includes 10 appendices that provide further details and data on federal response and recovery efforts. These areas cover key issues and challenges that GAO believes are critical for assessing the federal response and warrant continued Congressional and agency oversight during disaster recovery.

GAO is not making recommendations in this report, but has ongoing work that will address various response and recovery programs and challenges in more detail. GAO will make recommendations, as appropriate, once this work is completed.

In commenting on a draft of this report, DHS stated that the report highlighted the challenges of the complicated response and recovery efforts as well as provided insights into these efforts. DHS also noted that it is continuing to apply lessons learned from 2017 to improve its future program delivery and response efforts.

For more information, contact Christopher Currie at (404) 679-1875 or


November 18, 2015–June 6, 2016: The largest cholera outbreak (1,797 cases; attack rate 5.1 per 1,000) in the history of Dadaab refugee camp in Kenya occurred.


Golicha Q, Shetty S, Nasiblov O, et al. Cholera Outbreak in Dadaab Refugee Camp, Kenya — November 2015–June 2016. MMWR Morb Mortal Wkly Rep 2018;67:958–961. DOI:

“…..During November 18, 2015–June 6, 2016, the largest cholera outbreak (1,797 cases; attack rate 5.1 per 1,000) in the history of Dadaab refugee camp in Kenya occurred. Significant risk factors included living in a compound where open defecation, visible human and solid waste, and eating from a shared plate were common. Chlorine levels in water were below standard, and handwashing facilities were insufficient…..”

9/8/1900: A 15-foot storm surge from a Cat. 4 hurricane submerges Galveston, TX killing 6000-8000 inhabitants



9/5/1972: Black September terrorists storm the Olympic Village apartment of the Israeli athletes, killing two and taking nine others hostage.


“……In an ensuing shootout at the Munich airport, the nine Israeli hostages were killed along with five terrorists and one West German policeman...…”


Cape Town & Day Zero: The recent past; the global future?

Global Health Now

“……On January 1, 2018, the city announced an official limit for sustainable water use of 450 million liters per day for the entire province and declared Level 6 water restrictions, capping household water use at 50 liters per residence per day. Over 6 months, the city issued tenders to build 3 emergency desalination plants, and reduced agricultural use by 60%. The city raised funding to research water saving and recovery technologies and water source diversification—moving away from reliance on the city’s dwindling reservoirs as the main water source…..”

9/2/1666: The Great Fire of London breaks out in the house of King Charles II’s baker on Pudding Lane near London Bridge.


“……The Great Fire of London was a disaster waiting to happen. London of 1666 was a city of medieval houses made mostly of oak timber. Some of the poorer houses had walls covered with tar, which kept out the rain but made the structures more vulnerable to fire. Streets were narrow, houses were crowded together, and the firefighting methods of the day consisted of neighborhood bucket brigades armed with pails of water and primitive hand pumps. ….”


9/1/1983: Soviet jet fighters intercept a Korean Airlines passenger flight in Russian airspace and shoot the plane down, killing 269 souls




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