PUBLIC  HEALTH AND DISASTER.

 

                                  Peter Odada Sumba      Monday, April 21, 2003.

      

 Summary

 

 

Disasters are sudden happenings whose records have grown with human civilization.   Natural disasters were considered low key probability happenings of nature associated with bad omen in some society. As always disasters are associated with wide spread destruction of nature and infrastructures resulting in severe distress in the affected communities

 

 Disasters can be grouped into three major categories

 

(1)   Natural disasters, (2) Accidental disasters, (3) Man made disasters.

 

Natural disasters:

            -    Earthquake / Volcanic eruptions;

-         Floods;

-         Thunder and lighting;

-         Droughts;

-         Hurricanes and Tornados;

-         Disease outbreaks, (Cholera, Plagues, HIV/AIDS and SARS).

The new technologies today can enable us to predict the occurrence of the natural disasters in the world and prepare mitigations. Based on a number of factors the following are the top twelve countries with high probability of natural disasters in the world.

 Afghanistan; has frequent earthquakes, floods and droughts in 1988 floods 6,000 people died.

Algeria:  earthquakes and floods, 1980 earth quakes killed 3,600 people and 750 died in the November 2001 floods;

Bangladesh: floods, in 1987 and 1988 affected 70 million people, in 1991, Cyclone killed 138,000 people, 1970, wind and storm killed 300,000 – 500,000 people. The other countries are

Brazil, China, India, Indonesia, Iran, Italy, Philippines, Turkey and Vietnam. The details of disasters are found at http://www.btinternet.com/~mike.ferris/statistic3.htm

  The magnitude and lose that accompany disasters can not be over estimated when one looks back at the history. Between A.D.856 to March / 25/ 2002 there were 52 major earthquakes and volcanic eruptions and several floods and droughts experienced in different parts of the world. The damage and loss is unbearable when one adds the effects of Hurricanes and Tornados

 

Accidental disasters:

-         Wild forest fire, or any form of unexpected fire like what happened in Australia in early 2003;

-         General accidents involving  airplanes, ferries,

-         Motor vehicles or trains;

-         Oil leakage on land or sea;

-         Nuclear reactors or chemical malfunctions like the Chernobyl. Some of these accidents have adverse environment and health impact on human beings.

 

Man made disasters:

 

Man made disasters are turning out to be frequent and with heavy toll on human life,  destruction on infrastructures and environment and depleting the food resources. This has created fear in the human race than ever before. The consequences of wars cannot be easily determined on the population’s economic and health needs. The major impact comes much later and hardly does the affected population recover the lost treasures.

-         Wars and civil uprising;

-         Terrorists;

-         Bio-terrorists ;

Wars cripple all health systems by destruction of resources and infrastructures. Countries like Mozambique, Bosnia, Angola, Afarganistan and Iraq are among many countries of the world which have borne the casualties from disease epidemics and land mines among other crimes. It has neurological effects on children development and destroys social settings. In Rwanda about 500,000 lives were lost and many children left homeless. The psychosocial stress among the people results in many disease complications requiring major public health intervention. The result of current war engagement in the Middle East is hard to predict. The animosities may result in terrorists attack in future and it can occur anywhere in the world.

 http://www.members.iinet.au/~gduncan/maritime.html

 

      Nobody wants to remember what happened during September 11, terrorist attack in the USA and the bloody lose of life. This followed the attacks on the US embassy in Tanzania and Kenya by the same group out to score political goals.

  The terrorists are now focusing on the use of biological or chemical materials as tools of mass destruction. The preferred biological materials which can be used to cause wide spread and localized destructions are:

-         smallpox virus;

-          anthrax spores;

-          paramyxoviruses  (pneumovirinae);

-         ebola virus;

-         yellow fever, and other hemorrhagic viruses.

   People are never too young or too old to think about disaster preparation. Because of its impacts on health and social settings, public health practitioners should aim for global health risk awareness making it a family affair and promote dialogue and not confrontation.

 

Public health education:

 

 The society should be aware of critical earth science information on natural hazards including ocean logy, earthquakes, floods, volcanoes, wild land fires, landslides, and other geologic and hydrologic hazards. The availability of vital information may reduce the worlds’ vulnerability to disasters and provide steps for planning preventive measures.

     To achieve global humanization of public health, there is need to steer clear of politics and maximize local resources for better health.

·        During disasters, everybody is involved and adequate information                                  by the media, internet, radios, newspapers and other prints is quite

                                  important;                                  

·        The community should organize their resources to face the challenges like fast aid and transportation to health facilities;

·        It is important to chart out model of action with each group leader effectively communicating to other leaders for easy distribution of resources and procurement and supply of relief materials..

·        Creating contact network with relevant agencies about the events   can greatly improve the community’s health strategies and structures.

·        The cost evaluation and projection during disasters may not be done immediately but estimates can be relayed to other international organizations. When one looks at the cost of Hurricane Floyd and Hurricane Georges across 18 states in USA in 1998 and 1999 it was $ 11.9 billion dollars and 113 deaths. This is beyond the reach of a number of developing countries but with good coordination the reconstruction can be managed.. http://www.floodfacts.com/storm_green_disaster.html

 

Introduction

Disasters are sudden serious happenings with impacts which may be beyond coping by a country or community. After major disasters, there is panic and shock but survivors immediately get organized into rescue teams. Causalities occur mainly at the affected or the near by locations and require immediate medical attention. Assessment of the magnitude of injuries is done and treatment is organized based on the local capability. Epidemiology of health related issues to disasters emerge later and require specialized skilled team to evaluate. The effects normally vary within a given area. Disasters may result in a complete breakdown of infrastructure like in Mexico and Venezuela where thirteen hospitals, homes, bridges, railway lines and roads were either washed away by floods or destroyed by volcanic eruptions bringing to a halt the communication system. In such situations Relief Supplies and Drugs may not reach the affected communities in time resulting in unprecedented high number of casualties.

Essential Public Health Service

-         Improve the sanitations to prevent epidemics and the spread of diseases;

 

-         Disposal and handling of environmental hazards like chemical wastes, food remains and other household waste materials;

-         Response to disasters should be people driven and community centered for coping and recovery;

-         Involvement of local health providers will assure the continuity of the quality and accessibility of health services;

-         Surveillance to monitor and identify community health problems;

-         Diagnosis and data maintenance of health problems and environmental hazards in the community;

-         Inform, educate, and empower people about health issues by encouraging early treatment seeking and promotion of preventive medicine ;

-         Mobilize community partnerships to identify and solve health problems through discussions and media information;

-         Develop policies and plans that support individual and community health efforts by reviewing records of the health activities in the communities and note the successes and the shortcomings;

-         Enforce laws and regulations that protect health and ensure safety for every member, the application should be without favors;

-         Encourage competent public health and personal health care workforce motivated community health education.

-         Evaluate effectiveness, accessibility, and quality of personal and population based health services

Objective

  1. To ensure appropriate systems, procedures, and resources are in place to provide prompt, effective assistance to disaster victims;
  2. Facilitate formation of health networks for relief measures and rehabilitation services as an integral part of the national health management system;
  3. Sensitize the community to develop plans and programs for disaster prevention, mitigation, preparedness, response, rehabilitation and reconstruction.
  4.  To achieve these plans, clear mechanisms for coordinating with the local groups and international organizations must be put in place.

The sole purpose is to reduce vulnerability, implement the programs at reasonable cost and ensure continuity of services.

The main key to success in any disaster situation is accurate information by the local media agencies to the international world. Realization of change take time, even though people may not readily change we must keep on passing the vital information to them and provide appropriate education in emergency management and proper utilization of scarce resources available during this period of time.

 

Management and preparations for disasters are well documented by a number of organizations in the developed world but the link is missing in the developing countries.. In Africa, the lack of coherent disaster-related figures means the impact of the disaster is highly underestimated. In some cases it is so because of lack of cooperation from the political establishment fearing blacklisting by international world due lack of sound economic management. These countries bare the burden of disasters due to minimal technological development.

In the last decade alone, 4,777 natural disasters have taken more than 880,000 lives, affected the homes, health and livelihoods of almost 2 billion people around the world and inflicted approximately $687 billion in global economic losses. But thanks to the disaster mitigation programs, the loss of lives and homes has been less than it could have been.

Even though the number of disasters has more than tripled since the 1970s, the reported death toll has decreased to less than half.

The exception may be regions like southern Africa, where some 13 million people today are suffering from a food shortage. Famine threatens at least six southern African countries , Zimbabwe, Malawi, Zambia, Mozambique, Lesotho, and Swaziland; where lives are already being lost to hunger. Mozambique has suffered several disasters in the last decade, the civil uprising brought in mines every where in the country. The farms were mined resulting in reduced food production and subsequent hunger. This caused massive loses to civilian lives and animals. After the war there as been ravaging floods and frequent droughts.

 

Drought is a particularly difficult disaster to mitigate. Absence of a precise and universally accepted definition of drought adds to the confusion as to whether it exists, and if it does the degree of its severity, is often forgotten once it ends, and everybody seems to be caught unawares.

For a mitigation program to be successful, local leaders and residents must wholeheartedly adopt mitigation practices into their daily lives. Inhabitants of local communities are potential victims of natural disaster. They also represent the greatest potential source of local knowledge regarding hazardous conditions, and are the repositories of any traditional coping mechanisms suited to their individual environment. The local communities are those most aware of historical risk scenarios and the ones closest to their own reality.

Nature is hard to predict like single most terrible year in human loss in the last decade was 1991, when a cyclone devastated Bangladesh, killing 139,000 people. Cyclones are cyclical and they continue to hit the Bangladesh coasts but no such catastrophe has happened again. It is important though that the coastal residence take steps to mitigate any eventual happenings.

 

         TERRORISM

 

Since the terrorist attacks on Sept. 11 destroyed the World Trade Center in New York, damaged the Pentagon and killed about 3,000 people, all must be done to protect the people from future possible terrorists attack. This can be achieved through encouraged dialogue among the international communities to avoid wars and politics of hate. Countries should focus on education programs to strengthen knowledge on protection mechanisms to take when disaster falls. People should consider contacting their local health department, physician or local emergency preparedness office for information and any service. People should report any suspicious materials or people in their neighborhood.

Bio-terrorism

Preventing an attack is the job of law enforcement including all the security organs of a country and even local politicians, and other machineries of government. Diplomacy should be the guiding principle instead of force which encourages retaliations from the opposing groups. Today there are many biological and chemicals that can be used to cause disasters.

·        To avoid disasters we should take charge and keep safely the biological or chemicals under our management through research or work;

·        Information technology has become one single powerful tool to advance knowledge. Some of the discoveries in science should be evaluated before being released to the media for public use;

·        There should be bar codes on hot spots like genetic engineering of microorganisms and other chemicals which can be used for mass destruction;

·        If an attack should occur, minimize the risk and treat those who may become ill;

·        Public health practitioners should coordinate with state agencies, including local health departments, hospitals, laboratories and law enforcement;

·         Public health and other medical personnel should be trained to identify diseases that could be targeted by bio-terrorists;

·         Each country should form a well coordinated task force which would direct a coordinated effort among law enforcement, fire departments, emergency management, public health and other agencies at the local, and the top organs of the government at the national level for disaster mitigation. .

Vaccination against smallpox

 Vaccination has been shown to wear off in most people after 10 years, but may last longer if the person has been successfully vaccinated on multiple occasions. Health authorities should determine who to be given or who has been exposed to smallpox and are at risk of infection, and recommend re-vaccination.

·        It can be easily spread from person to person and transmission usually occurs only after the patient develops a fever and rash.

·         After the incubation period, the patient experiences high fever, malaise, headache and backache.

·        Severe abdominal pain and delirium are sometimes present.

·        The last naturally acquired case of smallpox in the world occurred in October 1977 in Somalia.

·        All known smallpox virus stocks are held under security at the CDC or at the State Research Centre of Virology and Biotechnology in Russia.

 Yellow fever

·        Yellow fever virus can easily be targeted by terrorist.

·        This virus or any other in the group like dengue virus, west Nile virus and other hemorrhagic viruses are transmitted through mosquito bites.

·        Infected mosquitoes can be bred and released in the environment.

·        The transmission contact can be reduced by using body repellants and chemically impregnated mosquito nets.

·        The travelers nets may acquired through the CDC in the USA and any other health offices in developing countries especially in Africa.

The other diseases which can easily be targeted are cholera, typhoid fever and even ebola virus, the dark star of the world’s infectious diseases. Their outbreaks can be controlled through integrated environmental management.

Humanitarian Assistance:      

Whenever possible, kindly contact humanitarian agencies for help and support. They can be involved in provision of aid to the communities, rehabilitation of the infrastructures, health services and socioeconomic developments.

 The following are External Agencies Providing Health and Other Humanitarian Assistance

UNITED NATION AGENCIES

The United Nation Office for the Coordination of Humanitarian Affairs(OCHA)

The United nation plays an important role in providing assistance in response to major humanitarian emergencies, as well as in promoting disaster reduction as part of development plans of countries. It coordinates response to natural or man made disasters, and promotes action to improve disaster prevention and preparedness.

Contact website: http://www.relifweb.int/ocha_ol

World Health Organization (WHO)

It is responsible for coordinating International Health action. The Pan American Health Organization (PAHO) and other WHO regional offices acts as focal points for national health authorities and donors after disasters in their respective areas WHO can provide technical cooperation in assessing health related needs, coordinating international health assistance, managing the inventory and distribution of relief supplies, carrying out epidemiology surveillance and disease control measures, assessing environmental health, managing health services, formulating cost estimates for assistance projects, and procuring humanitarian supplies. WHO and its regional offices can provide limited material assistance by reprogramming the country development activities or from other sources.

Contact website: http://www.who.int/eha

United Nations Children’s Fund (UNICEF)

Unicef works very closely with United Nation agencies and Non governmental organizations. Its emergency intervention focus on provision of health care, nutrition, water supply and sanitation, basic education and the psychosocial rehabilitation of traumatized children.

Contact website: http://www.unicef.org

 World Food Program (WFP)

It coordinates with others agencies to provide and ship food to victims all over the world. It has substantial resources to meet basic disaster food requirements.

Contact website: http://www.wfp.org

Food and Agriculture Organization of the United Nations(FAO)

Provides technical cooperation in long time agricultural development. It works to prevent food shortages when there is wide spread crop failures or disasters. Through the global information and early warning system, it issues monthly reports on world food situation and focusing on countries which could be facing disasters.

Contact website: http://www.fao.org

INTERGOVERNMENTAL ORGANIZTIONS

This include the European Community Humanitarian Office (ECHO)

Coordinates and oversee humanitarian activities in non member country during disasters. Provides important part of the operating budgets for humanitarian assistance for specialized UN agencies and is the second largest donor to world food program.

Contact website: http://europa.eu.int/comp/echo

Among others like Organization of America States, and Center for Coordination for the Prevention of Natural Disasters in Central America (CEPREDENAC) website: http://www.cepredenac.org

NON GOVERNMENTAL ORGANIZATIONS INCLUDE CARE,INTERNATIONAL RED CROSS AND CATHOLIC RELIEF SERVICES AMONG MANY

Contact websites: http://www.care.org , http://www.icr.org , http://www.catholicrelief.org 

 

 

 

Reference:

(1)   Lisa Bunosky public health management and natural disasters MPHP439 on line text book  (http://www.cwru.edu/med/epidbio/mphp439/chapter32.htm )

2.George Duncan Maritime disasters of World war ll contact web: http://www.members.iinet.au/~gduncan/maritime.html

3.Joshua Skillington Preparedness disaster news network (http://www.disasternews.net/preparedness )

4.International charter ‘Space and Major Disasters’- The charter http://www.disastercharter.org/charter_e.asp

5.      Simkin, T and Siebert, L, 1995 Volcanoes of the world: Geoscience press,Inc.,p.165-176.

6.    Earth and Volcanic eruptions p.1-6.  http://www.infoplease.com/ipa/A0001439.html

7.       Pan American Health Organization Scientific publication No.575: Natural Disasters:      Protecting the public’s health  p.1-109.

 8.     Butman AM. Responding to the mass casualty incident. A guide for EMS personnel.Akron, Ohio: Emergency training; 1982.

 9.       Wetterhall SF, Noji EK.Surveillance and epidemiology. In: Noji EK, ed. The public health consequences of disasters. New York: Oxford university Press; 1997.

10.    Center for Disease Control. Famine affected, refugee, and displaced populations: recommendations for public health issues. MMWR Morbidity and mortality Weekly Report !992; 41(RR-13): 1-76.