Transcript Public Health Effects

Public Health Effects
of Natural Disasters
COL David Crudo
Deputy Director
COE - DMHA
Disasters
A disaster is the result of vast ecological
breakdown in the relation between
humans and their environment, a serious
and sudden event (or slow, such as
drought) on such a scale that the stricken
community needs extraordinary efforts to
cope with it, often with outside help or
international aid.
SWA Gunn: Multinational dictionary of disaster
medicine and international relief, 1990
Asia Natural Disasters
1990 - 1999
Typhoon
Volcano
Events
32
20
Killed
186,000
110,000
186,000,000
1,100,000
60,641
223
Affected
$ damage
(millions)
2000 IFRC World Disaster Report
Natural Disasters
1990 - 1999
#
Deaths
Damage
Asia
2,071
406,199
$ 401.1 billion
Worldwide
4,864
595,537
$ 741.2
2000 IFRC World Disaster Report
Natural Disasters
Philippine Islands
Typhoon
1990
1991
1992
1993
1994
1995
1996
1997
1998
# Deaths Affected
4
1,151 10,100,000
3
5,788
7,600,000
2
187
2,900,000
8
587
4,800,000
9
230
3,200,000
6
1,490
3,740,000
7
50
200,000
7
49
367,000
7
491
2,270,000
Volcano
# Deaths
3
1
1
1
617
79
23
Affected
768,000
6,000
165,000
56,000
2000 IFRC World Disaster Report
Disasters
•
•
•
•
Defined by what they do to people
Unexpected # of deaths, injuries, illness
Destroy local medical infrastructure
Adverse effect on environment, increasing risk
for communicable diseases
• Affect psychological and social behavior
• Shortage of food with nutritional consequences
• Large, spontaneous or organized population
movements
Disasters
• Medical and health problems occur at
different times
• Severe injuries / trauma care mainly at
time and place of impact
• Increased risk of disease transmission
occurs later and in areas of crowding /
poor sanitation
Disasters
• Post-disaster pattern of health care needs change
– casualty and acute care management to
provision of primary care services
– environmental health concerns
•
•
•
•
•
•
•
supplying water
disposal of excreta and solid waste
ensuring food safety
providing shelter
personal hygiene needs and vector control
treat injuries during clean-up activities
public health surveillance
Short-term Effects of Major Natural Disasters
High Winds
(no flooding)
Effect
Earthquake
Deaths
Many
Severe injuries
Overwhelming Moderate
Few
Tsunami /
Flash Floods
Floods
Many
Few
Few
Few
Increased risk
Potential
for communicable
diseases
Potential
Potential
Potential
Food scarcity
Rare
Rare
Common
Common
Major population Rare
movements
Rare
Common
Common
Medical Myths and Realities of Disasters
Myth # 1:
Foreign medical volunteers with any kind of
medical background are needed.
Reality:
The local population almost always covers
immediate lifesaving needs. Only medical
personnel with skills that are not
available may be needed.
Medical Myths and Realities of Disasters
Myth # 2:
Any kind of international assistance is needed,
and it is needed now!
Reality:
Hasty response based on partial evaluation
contributes to chaos. Wait until genuine
needs have been assessed.
Medical Myths and Realities of Disasters
Myth # 3:
Epidemics and plagues are inevitable after
every disaster.
Reality:
Epidemics do not occur spontaneously after a
disaster, and dead bodies will not lead to
catastrophic outbreaks of exotic diseases.
The key to preventing disease is improved
sanitary conditions and education.
Medical Myths and Realities of Disasters
Myth # 4:
Disasters are random killers.
Reality:
Disasters strike hardest at the most vulnerable
groups - poor, women, children, elderly.
Disasters
Rapid Assessment
• Overall magnitude of effect (geographic extent,
# people affected, estimated duration)
• Effect on health (# of casualties)
• Integrity of health services delivery systems
• Specific health needs of survivors
• Disruption of services sectors (power, water,
sanitation) relevant to public health
• Extent of response by local authorities
Disasters
Environmental Health Aspects
• Interrupted safeguards (water, waste, shelter)
– increased rate of communicable diseases
– harmful effects of exposure to cold, heat, rain
• Relief efforts toward root cause rather than
consequence management
Disasters
Water Management
• Potable water - the most important immediate
relief commodity
– life-saving benefits
– promotes sanitation
• Adequate quantities for fluid replacement,
personal hygiene, cooking, sanitation
• Sufficient quality to prevent disease transmission
Disasters
Human Waste Disposal
• Improper management adversely affects
public health
• Urban - portable chemical toilets
• Rural - expedient form
• Control location and encourage concentration
Disasters
Shelter Management
• Immediate need (after food / water)
– increased mortality in displaced populations
subjected to cold stress
– high mortality in young, aged, infirm
• Include roof; may need groundsheet, blanket,
heating
• Monitor with public health surveillance
– diarrheal, respiratory, and vaccinepreventable diseases
Disasters
Communicable Diseases
• Myth of epidemics associated with disasters
– rare after rapid-onset disasters unless large #
of displaced people are placed in crowded /
unsanitary camps
– severe increased risk during and after
complex emergencies
• Perpetuated by media and politicians
• Public has exaggerated sense of risk posed by
dead bodies
Disasters
Communicable Diseases
• Disease will not occur if pathogen not present in
area and not introduced
• Outbreaks more likely in developing countries
• Increase in various disease vectors
– mosquito-borne
• malaria, dengue, filariasis, encephalitis
– water-borne
• contaminated supply; direct contact (leptospirosis)
Disasters
Communicable Diseases
• Loss of public utilities
– unclean water sources
• Disruption of basic health services
– brief interruption of preventative measures
may allow pathogens to spread
• Food scarcity
– relationship of malnutrition and diseases
– destroyed agriculture may lead to later
increase in mortality
Outbreaks Attributable to Rapidonset Natural Disasters (CDC)
Year
Country
Disaster
Disease
1970 Truk
typhoon
balantidiasis
1978 Marshall Is.
flood
acute URIs
1980 Mauritius
cyclone
typhoid fever
1988 Sudan
flood
diarrhea, malaria
1991 Philippines
volcano
measles
1994 USA
earthquake
coccidioidomycosis
1970 - 94: 38 disasters world-wide with no outbreaks reported
Outbreaks Attributable to Complex Emergencies
Year
1993
Country
Emergency Disease
Angola
civil war
dysentery, cholera
Armenia
refugees
none
Bosnia
civil war
none
Burundi
civil war
dysentery
Somalia
civil war
cholera
Sudan
civil war
measles, leishmaniasis
Swaziland
refugees
cholera
Tajikistan
civil war
cholera
1994 Angola
civil war
meningitis, hepatitis
Burundi
refugees
dysentery, cholera
Rwanda
civil war
dysentery
Sudan
civil war
none
Zaire
refugees
dysentery, cholera
1979 - 94: 32 disasters world-wide: 5 with no outbreaks reported
Theoretical Risk of Acquiring
Communicable Disease
Disaster
Person-toperson
Waterborne
Foodborne
Vectorborne
Typhoon
medium
high
medium
high
Volcano
medium
medium
medium
low
Tornado
low
low
low
low
Earthquake medium
medium
medium
low
Flood
medium
high
medium
high
Civil war
high
high
high
medium
Typhoons
Public Health Historical Perspective
• 90% of deaths from storm surge
• Trauma, GI illnesses, skin disease
– structural collapse, wind-blown debris
• Latent effects
– electrocutions
– cleanup injuries
– burns
– vector-borne
disease increase
– mental health
Volcanoes
Hazards associated with eruptions
• Blasts
– rock projectiles
– sound waves
• Pyroclastic flows
and lahar
Volcanoes
Hazards associated with eruptions
• Ashfall
– building collapse
– respiratory disease
– ocular injury
– toxic effects
– infectious hazards
• Asphyxiant gases
• Acid rain