Earthquakes
are amongst the most unpredictable natural disasters people can experience. In a
matter of moments, with little or no warning, tens of thousands of people are
put in danger.
One
of the imminent threats survivors fear is the spread of disease. However, not
all we hear about public health concerns and cadavers being the source of
epidemics is necessarily true. Nonetheless, we must try to prepare ourselves for
such situations.
In
the wake of a disaster, people naturally want to help. In addition we ask
ourselves, if the unthinkable should happen, what should I do if I was a
survivor in the midst of such carnage and catastrophe?
Public
Health Consequences of Earthquakes
Inaccurate
and unfounded information on the public health consequences of natural disasters
is commonly disseminated through informal channels of communication and relayed
by the media, which often does not check facts. The problem with these
myths and rumors is that they often mislead potential donors and inadvertently
promote misallocation of resources.
The
myths are always the same – the looming specter of epidemic because of the
dead bodies or the disruption of public services (particularly water), need of
foreign medical assistance, need of large quantities of medical supplies and
camp hospitals, need to resettle the population in camps, and need of food
assistance. The truth is that, from a public health standpoint, situations
normalize in a matter of a few weeks, if not days.
Immediate
Health Problems Related to Earthquakes
The
demand for health services occurs within the first 24 hours of an event. Injured
people may continue to appear at medical facilities only during the next three
to five days, after which presentation patterns return almost to normal.
Patients tend to appear in two waves, the first consisting of casualties from
the immediate area around the medical facility and the second of referral as
humanitarian operations in more distant areas become organized. Victims of
secondary disasters may arrive at later stages.
Eighty-five
to ninety-five percent of persons rescued from collapsed buildings are rescued
in the first 24-48 hours after the earthquake. A week after the earthquake, the
surgical demand and the demand in health care in general is typically back to
normal. Late arrival of referred patients and injuries due to secondary
disasters may occur. Little information is available about the kinds of injuries
resulting from earthquakes, but regardless of the number of casualties, the
broad pattern of injury is likely to be a mass of injured with minor cuts and
bruises, a smaller group suffering from simple fractures, and a minority with
serious multiple fractures or internal injuries requiring surgery and other
intensive treatment. Fatalities are nearly instantaneous with the event.
Epidemic
Risk After Natural Disasters
Natural
disasters do not import diseases that are not already present in the affected
area. Furthermore, outbreaks of communicable diseases do not usually occur
after earthquakes (and after any natural disasters) although the risk of an
increasing incidence of sporadic cases (below epidemic threshold) exists.
Epidemic risk factors in the aftermath of an earthquake are the rupture of water
sanitation infrastructures, the interruption of public health services such as
immunization among children, interruption of sanitation measures in urban
settings, and interruption of control of vectors like mosquitoes and rodents.
Usual post-disaster sanitation measures combined with the strengthening of the
disease surveillance system are typically sufficient for controlling
transmission of epidemic-prone diseases.
Management
of Dead Bodies After a Disaster
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One
of the most common myths is that cadavers are the source of epidemics
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One
of the most common myths associated with natural disasters is that cadavers are
the source of epidemics. In fact, according to the World Health Organization
(WHO), the health hazard associated with dead bodies is negligible.
Contamination may occur in very limited cases when the cadavers are in contact
with the water system and transmit gastro-enteritis. In the case of cholera,
cadaver removal has little impact on the transmission of the disease. Rather,
the hygienic measures and the control of water quality for the survivors are
essential for controlling the transmission of cholera. Diseases transmitted by
mosquitoes such as malaria and dengue are not associated with the presence of
cadavers. A relationship between cadaver and epidemics has never been
scientifically demonstrated or reported. However, the scientific argument cannot
override both the cultural obligation to take care of dead bodies and the mental
health consequences that open mass graves and uncollected bodies produce on the
population.
What
is the Best Response?
Based
on the 1999 experience in Turkey, national and international health agencies,
including the WHO, cited secondary prevention and management of crush syndrome
cases as the major needs facing health services and the survivors in an
earthquake disaster region, such as Bam. Crush syndrome refers to a host
of serious medical complications that follow unattended traumatic injuries. These are commonly faced in areas where the injured may not be reached for long
periods of time. In the immediate aftermath of an earthquake, trauma
patients need to receive intravenous (IV) fluids and such fluids need to be
available in large quantities in the areas of damage. The management of crush
syndrome cases requires dialysis for renal failure. Assessment of hospital
capacity in the country will measure the current hospital response capacity for
the management of complex trauma patients.
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Disaster
relief should be targeted and focused to avoid an unnecessary duplication of
resources covered by international health NGOs already present in the field
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In
general, disaster relief should be targeted and focused. The direct
shipment of untargeted medical supplies is not recommended and may lead to an
unnecessary duplication of resources covered by international health NGOs
already present in the field. In general, the following recommendations for
people, agencies and governments have been issued in the aftermath of other
earthquakes in the region:
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Do
not send used clothing, shoes: in most cases, the local community donates
more than enough of these items to meet the demand. It is more economical,
convenient and sanitary to purchase items locally than to ship used items.
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Do
not send household medicines or prescriptions: these items are sometimes
medically and legally inappropriate. Pharmaceutical products take up needed
space and divert the attention of medical personnel from other more pressing
tasks to sort, classify, and label them.
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Do
not send blood and blood derivatives: there is much less need for blood than
the public commonly believes. Local blood donors in the affected country
will cover the victim's needs. This type of donation is unsuitable because
it requires quality and safety controls, such as refrigeration or screening
for detection of HIV.
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Do
not send medical or paramedical personnel or teams: local health services
are able to handle emergency medical care to disaster victims.
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Do
not send field hospitals, modular medical units: considering that this type
of equipment is justified only when it meets medium-term needs, it should
not be accepted unless it is donated.
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Do
not make unilateral decisions on resource allocation without evidence of
needs.
There
is little question that during and immediately after a disaster, needs are acute
and the human tendency to help and succor comes to the fore. Yet, as is
shown above, as the dust begins to settle hope rekindles, and the ability of
most agencies to handle disaster assures that the survivors will be able to make
the road to recovery.
*
David W. Tschanz, PhD has a master's degree in public
health/epidemiology from the University of South Carolina. He is also a
medical/military historian, web developer, editor and demographer. You may
contact him by sending your emails to: Desertwriter1121@yahoo.com.
