the likely paths of hurricanes. The ben- eﬁts of universal education and eradica- tion of illiteracy are that the population is aware of the risks associated with hurricanes and understands government warnings. The importance of issuing early warnings to the population cannot be overemphasised and has been shown to be effective in reducing deaths for a variety of extreme weather events.3 It is important to recognise that Cuba has a population with a very high level of civil participation. The majority of the popu- lation are members of different mass organisations, and there is a strong sense of community spirit. Hurricane awareness is taught in schools, and 72 h prior to a hurricane, national media issue alerts are given while civil protection committees check evacu- ation plans and shelters.20 Following hur- ricane Dennis in 2005, which resulted in 17 deaths within Cuba, a greater aware- ness of the risks associated with hurri- canes has been emphasised to the Cuban population.19 Forty-eight hours prior to the hurricane, authorities inform high- risk areas and evacuation commences. Prior to hurricane Ike, 2.6 million people (23% of the population of Cuba) were evacuated and housed in shelters.17 PREPARATION IN CAMAGÜEY PROVINCE Prior to the hurricane reaching Camagüey province, which has a population of just under 800 000, senior health professionals identiﬁed groups that were at the greatest risk. This included approximately 300 chil- dren with signiﬁcant medical prob- lems, 8000 infants and 4000 pregnant women. Children were discharged from the hospital where appropriate, and the emergency departments were prepared for admissions. Paediatric health pro- fessionals were allocated to each of the evacuation centres. In the 24 h fol- lowing hurricane Ike, there were over 500 emergency cases presenting to the Children’s Hospital in Camagüey. Ninety-six of these children required admission, and four required surgery. RECUPERATION STAGE Healthcare following the hurricane is essential. In particular, the importance of hygiene and sanitation was empha- sised to minimise the increase in acute gastroenteritis. Following the hurricane, there was a 10% increase in gastroenteri- tis. Within a week of the hurricane, all 8000 infants in Camagüey Province were Arch Dis Child April 2011 Vol 96 No 4 visited in their homes by the family doc- tor, nurse or other health professional. This was only possible because Cuba has one of the best primary healthcare sys- tems in the world with the highest ratio of doctors per capita worldwide.21 22 Each family doctor and nurse is responsible for between 120 and 160 families. Health professionals kept a special lookout for mental health problems in children fol- lowing the hurricane, as it is recognised that these are signiﬁcant problems.23 CONCLUSIONS The economic damage caused by hur- ricanes Gustav and Ike (two category four hurricanes) to Cuba was substan- tial. However, by a combination of early warnings and preparation alongside the evacuation of almost a quarter of the population of Cuba, only seven lives were lost (box 1). Both Jamaica and the Dominican Republic have used the mass media in a similar manner to Cuba to try and increase awareness among indi- viduals of the dangers associated with hurricanes and how appropriate prepa- ration can reduce casualties.20 Equally important as preparation prior to the hurricane is ensuring the provision of shelter, food and water alongside health- care after the hurricane for all individu- als in affected areas (box 1). This should be provided by the government of the affected country and is easier to pro- vide if there is universal healthcare. As extreme weather events are likely to increase with climate change, it is important that other countries take on board the Cuban experience in order to minimise the loss of human lives. Box 1 Measures to minimise casualties for hurricanes Before the hurricane ▶ Early warning and preparation of population ▶ Organised evacuation ▶ Identiﬁcation of groups at risk After the hurricane ▶ Provision of shelter, food and water ▶ Provision of healthcare, especially to groups at risk Competing interests None. Provenance and peer review Commissioned; externally peer reviewed. Accepted 28 July 2010 Published Online First 22 September 2010 Arch Dis Child 2011;96:328–329. doi:10.1136/adc.2009.178145 Leading article REFERENCES 1. Shultz JM, Russell J, Espinel Z. Epidemiology of tropical cyclones: the dynamics of disaster, disease, and development. Epidemiol Rev 2005;27:21–35. 2. National Hurricane Center. http://www.nhc. noaa.gov/pdf/NWS-TPC-5.pdf (Accessed 15 December 2009). 3. Ebi KL, Schmier JK. A stitch in time: improving public health early warning systems for extreme weather events. Epidemiol Rev 2005;27:115–21. 4. National Oceanic and Atmospheric Association. 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