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With increasing passage of time after a disaster, both decision makers and the public become progressively less concerned with the probability of epidemic disease. Initial enthusiasm also wanes for providing emergency health services to affected communities and temporary settlements, and many bilateral and voluntary disaster relief agencies begin phasing out activities. Normal communications and transportation, as well as disease notification systems and control efforts, are restored. The phasing out of the intensified, disaster-related surveillance activities should take place after consultation with members of the national epidemiology group. Certain areas, such as permanent encampments of refugees, may require indefinite special surveillance. In rural or remote areas, the phasing out of postdisaster surveillance may mean that all notification of disease ceases. Organized effort to maintain effective surveillance in such areas has not, in the few instances when it has been tried, been particularly successful. On the other hand, such an effort has never been of high priority or received significant economic support from authorities of disaster-affected countries or development agencies. In the past several years, however, the Pan American Health Organization has assigned high priority to developing or strengthening epidemiologic surveillance programs after disaster. In some countries, the monitoring of postdisaster recovery in the health sector has been an additional objective.
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