WMA Declaration of Montevideo on Disaster Preparedness and Medical Response

Adopted by the 62^nd WMA General Assembly, Montevideo, Uruguay, October 2011
and revised by the 77th WMA General Assembly, Rotterdam, the Netherlands, October 2026

PREAMBLE

In the last decade, we have seen a global increase in the frequency and severity of extreme events which seriously test and overwhelm the capacity of local healthcare and emergency medical response systems. Armed conflicts, and natural disasters such as earthquakes, floods, extreme weather events, and wildfires, have consequences for the health of people living in these areas, as well as neighbouring communities and countries, intensifying humanitarian, health system, and migration pressures. These disasters have increasingly drawn the support and response of the international community.

The number of civilian deaths due to armed conflict has reached an unprecedented magnitude in 2024 according to the United Nations Human Rights Office, to at least 48,384 deaths. Each year, disasters cause hundreds of deaths and cost billions of dollars due to disruption of commerce and destruction of homes and critical infrastructure. Similarly, evidence indicates that global pandemics are becoming more frequent and severe.

Populations made vulnerable by systemic challenges (e.g., due to overconsumption of resources, increased population density, urbanization, aging) has increased the risk and impact of disasters and public health emergencies. Globalisation, which connects countries through economic interdependencies, has led to increased international travel and commerce. Such activity has also led to increased population density in cities around the world and increased movement of people to coastal areas and other disaster-prone regions.

Climate change and conflict have emerged as important global factors that can influence disaster trends and thus require continued monitoring and attention.

Additionally, there is an increased recognition of the impact of Social Determinants of Health on the long-term effects and recovery of populations made vulnerable by disasters and conflict.

In light of these trends, national and local governments need to have comprehensive and fully-tested plans for disaster preparedness, with strategies for prevention, detection and response. These plans must be accompanied by sustainable financing and take into account practical feasibility and system capacity. During disasters, national and local governments will likely be required to make decisions in the context of uncertain or evolving information. As such, disaster preparedness plans must emphasise the need for decisions to be guided by a precautionary approach which prioritises safety, including the safety of healthcare staff, patients and the public.

Healthcare systems therefore need to enhance workforce preparedness by providing adequate support and training to become more proficient in the recognition, diagnosis, and treatment of mass casualties under an all-hazards approach to disaster management and response. This support and training must ensure healthcare personnel are able to recognize the general features of disasters and public health emergencies and be knowledgeable about how to report them, the response protocols to follow and where to get more information should the need arise. Mechanisms should be in place to ensure that, during the course of a disaster, healthcare personnel receive adequate support both in relation to the disaster response and their own health and wellbeing.

RECOMMENDATIONS

Recalling the WMA Statement on Medical Ethics during Public Health Emergencies, the International Code of Medical Ethics, the WMA Declaration of Delhi on Climate Change and the WMA Statement on Epidemics and Pandemics, and the WMA Statement on Armed Conflicts, the WMA recommends:

The World Health Organization to:

1. In collaboration with its partners including meteorological associations, strengthen the global monitoring infrastructure for detecting and responding to natural disasters and conflict.
2. Provide tools for member states to develop, strengthen, and sustain national disaster preparedness programs.
3. Facilitate cross-border partnerships and international collaborations especially in large-scale disasters.
4. Expand technical support for community-based disaster risk reduction programs aiming at promoting local ownership and resilience beyond hospital responses.
5. Develop data-sharing agreements, regional simulation exercises, and interoperable alert systems that align with the International Health Regulations.
6. Create emergency Standard Operating Procedures for international collaboration, assistance, and support for managing disasters.

National and Local Governments to:

7. Establish or update regional databases and geographic mapping of information on health system assets, capacities, capabilities, and logistics.
8. Develop systems to assess the medical needs, disease patterns of affected populations, and their geographical distribution, to assist medical response efforts, domestically and worldwide.
9. Develop and periodically test warning systems and disaster management plans.
10. Work collaboratively across ministries and local government entities, to ensure a comprehensive plan is developed.
11. Ensure that disaster-preparedness and response frameworks meaningfully integrate culturally informed approaches, particularly for communities with distinct historical, structural, or socio-cultural contexts.
12. Provide sustainable financing to create and maintain disaster preparedness programs and qualified emergency response personnel.
13. Apply a health equity lens to disaster response in order to facilitate a robust recovery for the most vulnerable who are often disproportionately affected by disasters
14. Support and strengthen the health workforce´s ability to provide emergency care and regular health services without interruption during disasters
15. Ensure both health and public health systems have adequate capacity and resilience to respond to a wide range of potential disasters, including through continuity planning for disruptions to critical infrastructure such as electricity, water supply, heating, information technology systems, and telecommunications, in order to maintain essential health services and patient care during crises and disasters.
16. Ensure that physicians and other first responders have their daily needs met, preventing them from consuming local resources, and have access to the necessary medical supplies and equipment, including Personal Protective Equipment.
17. Establish mechanisms to ensure appropriate health management for administrative personnel in affected areas who are engaged in extensive disaster response activities, in addition to physicians and frontline emergency responders.
18. Identify or establish systems for direct communication with physicians and other front line emergency response personnel.
19. Manage the flow of information and create mechanisms to control misinformation.
20. Ensure adequate legal protection for public health and healthcare responders in a disaster.
21. Share best practices and lessons learned from disaster planning and response activities new scientific knowledge and information to enhance the medical and public health response.
22. Consult with the medical profession and wider healthcare workforce on the development and review of disaster plans in order to ensure plans are evidence-based, practical, adaptive, responsive and supported by the workforce.
23. Consult with the wider public including those from marginalised and communities made vulnerable on the development and review of disaster plans.
24. Conduct research on:

• the safety and efficacy of the therapeutic and public health interventions undertaken during the disaster,
• the short and long-term health impacts of the disaster itself including the direct impacts (such as disaster-related injuries or sickness) and the indirect impacts (such as delayed preventative screenings), and
• the short and long-term health impacts of the disaster response.

Medical Associations and their members to:

25. Advocate for a competency-based framework in disaster response training for all physicians, including core competencies, role-specific competencies, and adaptation to national contexts and health systems capacities, both during undergraduate and all stages of postgraduate and continuing medical education.
26. Establish or advocate for mental health and psychosocial support responses that are sensitive to local contexts, strengthen social support systems, and provide dedicated support for physicians and frontline emergency responders in line with internationally recognised frameworks such as the Inter-Agency Standing Committee Guidelines.
27. Actively participate in the development and testing of emergency and disaster response plans at the national and local level
28. Provide medical expertise and work collaboratively to develop public health policies that are:

• designed to improve the effectiveness and access to medical services during a disaster,
• evidence-based,
• based on respect for patients.

Health and care facilities to:

29. Examine the barriers and facilitators that the medical personnel will encounter following a disaster.
30. Incorporate, within their hospital disaster plans, workplace and personal preparedness efforts that reduce barriers to staff responses during a disaster, both within their institutions and across the community.
31. Individual physicians should acquire and maintain the competencies necessary to provide safe, effective, and timely medical services during a disaster, and contribute to early identification, reporting, and communication of public health risks.