Natural Disasters: Coping with the Health Impact

measures and increasing the coping capacity and preparedness o- the health sector and community. This -act sheet will -ocus on cost-e--ective solutions to address natural disasters. The Nature of Disasters Health and economic losses -rom natural disasters disproportionately a--ect developing countries 4which account -or more than 90 percent o- natural disaster-related deaths 4and predominantly a--ect the poor within those countries.<br><br> Although the total economic loss in dollars is greater in developed countries, the percentage o- losses relative to the gross national product in developing countries -ar exceeds that o- developed nations. Natural disasters are not random. Earthquakes and volcanic eruptions occur along the -ault lines between two tectonic plates on land or the ocean foor.<br><br> And the areas subject to seasonal -loods, droughts, or tropical storms (cyclones, hurricanes, or typhoons) are well known, although global warming is redrawing the map o- climatic disasters. Local populations, however, may not recognize the risks in these areas. Technological disasters and complex emergencies are less predictable.<br><br> Few countries are immune to the public health risks -rom hazardous chemical substances (-rom insecticides to industrial by-products) or discarded radioactive material. Technological hazards increase rapidly with the largely unregulated industrialization o- developing countries and the globalization o- the chemical industry, suggesting that chemical emergencies may become a major source o- disasters in the 21st century. A population 9s vulnerability to all types o- disasters depends on demographic growth, the pace o- urbanization, settlement in unsa-e areas, environmental degradation, climate change, and unplanned development.<br><br> Poverty also increases vulnerability due to lack o- access to healthy and sa-e environments, poor education and risk awareness, and limited coping capacity. 2 | Natural Disasters: Coping with the Health Impact | Disease Control Priorities Project Immediate Health Impact Short-term losses -all under three categories that have both direct and indirect e--ects: " illness, disability, and death; " direct losses in infrastructure; and " loss or disruption in health care delivery. The immediate health burden depends on the nature o- the hazard.<br><br> In the a-termath o- a major disaster, authorities must meet extraordinary demands with resources that cannot begin to meet even basic health needs and that o-ten have been drained by the immediate emergency response. Disasters related to natural events may a--ect the transmission o- preexisting in-ectious disease, but the imminent risk o- large outbreaks in the a-termath o- natural disasters is o-ten overstated. In the short-term, an increased number o- hospital visits due to diarrheal diseases, acute respiratory in-ections, dermatitis, and other causes should be expected -ollowing most disasters.<br><br> In the medium term, heavy rain-alls may a--ect the transmission o- vector-borne diseases, -or example, -rom residual water that may contribute to an explosive rise in mosquitoes. Earthquakes can cause a large number o- injuries. While most are not li-e-threatening, the injured do require immediate medical care -rom health -acilities that are o-ten unprepared, damaged, or totally destroyed.<br><br> Authorities must provide services to a displaced population, rehabilitate health -acilities, restore normal services, and strengthen communicable disease surveillance and control. They must also attend to the long-term consequences, such as permanent disabilities, mental health problems, and possibly increases in rates o- heart disease and chronic disease. Tsunamis are catastrophic tidal waves caused by earthquakes on the ocean -loor.<br><br> Waves can travel several hundred kilometers per hour and can be as much as 10 meters high when they reach shore. Damage on shore can be extensive, and usually the number o- deaths -ar exceeds the number o- survivors with severe injuries. Volcanoes cause serious problems, yet are o-ten overlooked because o- long periods o- inactivity.<br><br> Eruptions are preceded by a period o- volcanic activity, which gives people time -or scienti c monitoring, warning, and preparation. Some issues, such as ash -all, lethal gases, lava fow, and projectiles, although o- public concern, are o- minimal health signi cance. Falling ash a--ects transportation, communications, water sources, treatment plants, and reservoirs.<br><br> Volcanic ash and gases can irritate the eye membranes and upper respiratory tract and can exacerbate chronic lung conditions, but usually cause little sickness in the general population. The most important risk is posed by pyroclastic fows (hot gas, ash, and rock traveling with intense speed -rom the blast) and lahars , or gas, ash, rock, and/or mud fows mixed with water, caused by the rapid melting o- a volcano 9s snowcap or by heavy rains on unstable accumulations o- ash. Historically, pyroclastic explosions or lahars have caused about 90 percent o- the casualties -rom volcanic eruptions.<br><br> Other concerns are potential contamination o- water supplies by minerals -rom ash; displacement o- large populations -or an undetermined time; related sanitation problems; and mental health needs. Climate disasters include seasonal foods, hurricanes, and typhoons. Seasonal -loods cause increased incidence o- diarrheal diseases, respiratory in-ections, dermatitis, and snake bites.<br><br> The risk o- compromised water supplies depends on the condition o- the community 9s water supply be-ore the disaster. Saline contamination is a long-term issue -ollowing sea surges and tsunamis. Prolonged fooding endangers local agriculture and sometimes means large-scale -ood assistance will be needed.<br><br> The primary health concerns are overcrowded living conditions and poor water and sanitation in temporary settlements and other areas where services have deteriorated or are suspended. Sickness and death result -rom high winds, heavy rain-all, and storm surges caused by tropical storms, such as hurricanes and typhoons. Survivors o- such disasters require psychosocial services.<br><br> Long-Term Impacts The health sector bears a signi cant share o- the long-term economic burden -rom disasters. The value o- direct damage and indirect losses together make up the total cost o- disasters. Direct damage re-ers to the material losses that occur as an immediate consequence o- disaster: hospital beds lost, equipment and medicines destroyed, health service -acilities damaged or a--ected, and pipes and water plants destroyed.<br><br> Indirect losses re-er to the production o- goods and services that are lost as an outcome o- the disaster, and to the resulting reduced income. The health burden o- disasters includes damage to housing, schools, channels o- communication, and industry. Damage to hospitals, health -acilities, and water and sewage systems have the biggest impact on health.<br><br> The long-term health burden includes loss o- medical care, interruptions in the control o- communicable disease and other public health programs, and loss o- laboratory support and diagnostic capabilities o- hospitals. A common misperception is that the damage to critical health -acilities is promptly repaired, but experience shows that damaged health in-rastructure recovers at a slower pace than other service sectors, such as trade, roads, bridges, telecommunications, and housing. Damage to water and sewage systems can also have a great impact on health.<br><br> In severe fooding, the sudden interruption o- these services coincides with the direct e--ect on the transmission o- water-borne or vector-borne diseases. In the case o- earthquakes, the number o- people adversely a--ected by water shortage may -ar exceed those injured or su--ering direct material loss. As in the case o- health care -acilities, the rehabilitation o- public water systems is usually slow.<br><br> Disaster Response and Prevention Disaster preparedness prevents an uptick in the local problems that health services normally handle. The immediate emergency response is provided under a highly political and emotional climate, and the responsibilities o- the national or local health authorities are signi cant: " Assessment of the health situation must be rapid, simple, transparent, technically credible, and done in collaboration with nongovernmental actors, donors, and the World Health Organization. " Effective treatment of mass casualties depends on local preparedness and requires triage o- patients to treat those most likely to bene t rst.<br><br> " Surveillance, prevention, and control of communicable diseases during disasters should be strengthened by quickly and opportunistically resuming and monitoring the routine control programs, rather than resorting to new and expensive measures. " Prioritizing environmental health 4water quality, vector control, excreta disposal, solid waste management, health education, and -ood sa-ety 4is essential, especially in temporary settlements. " Donations and supplies must be transparently managed to improve the fow o- assistance to intended bene ciaries.<br><br> " Strong coordination of the humanitarian health e--orts maximizes the bene-it o- the response and ensures it is compatible with the public health development priorities o- the a--ected country. The need -or preparedness cannot be overemphasized. Building local capacity is one o- the most cost-e--ective ways to improve the quality o- the national response.<br><br> Disaster preparedness is primarily a matter o- building institutional capacity and human resources, and includes: " Identifying vulnerability to natural or other hazards; " Building simple and realistic health scenarios of a possible and probable occurrence; " Initiating a participatory process among the main actors to develop a basic plan that outlines the responsibilities o- each actor in the health sector, identi-ying possible overlaps or gaps and building a consensus; " Maintaining close collaboration with these main actors; and " Sensitizing and training the 8rst health responders and managers to -ace the special challenges o- responding to disasters. Preventing and mitigating the damage to health -acilities is important. Reducing the physical vulnerability o- the in-rastructure can take place when reconstructing the in-rastructure destroyed by a disaster, when planning new in-rastructure, or when strengthening existing -acilities.<br><br> Mitigation of damage to hospitals aims to ensure the continuing operation o- the health -acility, so that some basic services will continue uninterrupted in the event o- a disaster. Reducing the damage to water supplies is also important, and requires cross-sectoral coordination. The Best Buys in Disaster Scenarios Natural disasters are emergency situations.<br><br> However, with planning, costly and ine--ective interventions can be avoided. Improvisation and rush inevitably come with a high price, and there are many things health o- cials ought to avoid 4 pre-erential use o- expatriate health pro-essionals; emergency procurement and airli-ting o- -ood, water, and supplies that o-ten are available locally or that remain in storage -or long periods o- time; the tendency to adopt dramatic measures 4 all contribute to making disaster relie- one o- the least cost- e--ective health activities. 3 | Natural Disasters: Coping with the Health Impact | Disease Control Priorities Project But, cost-e--ective interventions can be adopted: " As an alternative to expensive search and rescue teams (SAR) dispatched by developed nations, the resources invested should instead go toward building the capacity o- local or regional SAR teams 4the only ones able to be e--ective within hours 4and training local hospitals to dispatch their emergency medical services to disasters sites.<br><br> " Rather than investing in foreign field (mobile) hospitals, -unds would be more e--ective in the construction and equipping o- simple, but sturdy temporary -acilities, and instead using the mobile hospitals -or the medium-term to handle nontrauma needs. " Recipient countries should clearly prepare a list o- the supplies and equipment they need, rather than allowing unsolicited in-kind donations o- inappropriate medical supplies that are o- limited use and o-ten cause serious logistic, economic, and political problems. " Improvised mass immunization or vector control programs should be eliminated, in -avor o- post- disaster interventions in surveillance and control o- communicable diseases that -ocus on strengthening existing programs, " Construction material, or preferably cash subsidies, should be distributed, rather than constructing massive tent cities, which should be a last resort.<br><br> " The distribution of in-kind relief goods, such as food or blankets, should be abandoned, in -avor o- direct nancial assistance in the -orm o- subsidies, grants, or tax relie-, wherein the individual is -ree to determine priorities and to seek the most cost-e--ective sources o- shelter, medical, -ood, or other. By -ar the best thing that countries can do is be better prepared -or disasters. To do this, they must secure -unding -or preparedness activities.<br><br> The capacity o- ministries o- health or other responsible authorities to secure -unds depends on the existence o- an established disaster program, ongoing dialogue with donors, realistic projections o- activities, and technical endorsement and support o- WHO and other UN agencies. Those countries with established disaster preparedness programs advocate a multihazard program covering the entire health sector as the most e--ective approach. The occurrence o- a major disaster can be the initial catalyst that helps health authorities recognize that disasters are a public health risk that must be addressed in an organized manner.<br><br> Yet, preparedness cannot wait. There needs to be a continuum between normal development, preparedness, and disaster response activities. Disasters are not likely to decrease in the -oreseeable -uture.<br><br> A sustained e--ort is needed to minimize risk, by reducing vulnerability through prevention and mitigation and by increasing capacity through preparedness measures. Disasters, like any public health program, need to be addressed on a long-term and institutionalized basis through an established ministry o- health program or department -or prevention, mitigation, preparedness, and response -or all types o- disasters. And the economic and political dimensions o- disasters should not be allowed to overshadow the -act that disasters are a human tragedy which requires an international initiative to identi-y the best practices and the inadequacies o- responses to date.<br><br> References Claude de Ville de Goyet, Ricardo Zapata Marti, and Claudio Osorio. 2006. cNatural Disaster Mitigation and Relief. d In Disease Control Priorities in Development Countries, 2 nd ed. D. T. Jamison, J. G. Breman, A. G. Measham, G. Alleyne, M. Claeson, D. B. Evans, P. Jha, A. Mills, and P. Musgrove, 591- 603. New York: Ox-ord University Press.<br><br> www.dcp2.org

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