Earthquakes and Public Health: Myths & Realities

Iran's Dec 26 earthquake killed at least 30,000 people

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

One of the most common myths is that cadavers are the source of epidemics

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.

Disaster relief should be targeted and focused to avoid an unnecessary duplication of resources covered by international health NGOs already present in the field

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:

• 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.
• 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.
• 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.
• Do not send medical or paramedical personnel or teams: local health services are able to handle emergency medical care to disaster victims.
• 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.
• 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 Tschanz is a medical/military historian currently based in Saudi Arabia. He is also an epidemiologist, web developer, computer systems engineer, editor and demographer. You may contact him by sending your emails to: Desertwriter1121@yahoo.com.