General effects of Disasters on Health 2011.11.07 International health and health management Prof. Naoki NAKAZONO Term Disaster refers to the natural event (,,,) in combination with its damaging effects (loss of life, destruction of ,,,). Hazard refers to the natural event. Vulnerability refers to the susceptibility of population or system to the effects of the hazard. Risk is The probability that a particular system or population will be affected by hazard. Risk is a function, expressed as Risk=Vulnerability x Hazard Disasters affect areas with different levels of vulnerability with distinct social, health, and economic conditions. However, there are still similarities between disasters. Lesson learned from Disasterｓ Our goal is to optimize the management of health humanitarian assistance and use of resources, to make strategic decisions to relieve the victims and to reconstruct the health system (response, mitigation) to make disaster preparedness. Lesson learned from Disasters There is a relationship between the type of disaster and its effect on health. Some effects are potential, rather than inevitable, threat to health. The actual and potential health risks after disaster do not occur at the same time. Disaster-created needs for food, shelter, and primary care are usually not total. Civil wars and conflicts are also public health problems. Health problems common to all natural Disasters Social Reactions Communicable Diseases Population Displacements Food and Nutrition Water Supply and Sanitation Mental Health Damage to the Health Infrastructure Social Reactions After a major disaster, behavior rarely reaches generalized panic or stunned waiting. Spontaneous individual action accrues as survivors rapidly recover from their initial shock. Survivors begin search and rescue activities. Antisocial behavior, widespread looting occurs only in exceptional circumstances. Rumors abound, particularly of epidemics. People are reluctant to evacuate, even if their homes are to be or have been destroyed. Communicable Diseases(CD) In certain circumstances, natural disasters increase the potential for disease transmission. Enteric disease caused by fecal contamination of water/food Risk of epidemic outbreaks of CD is proportional to population density and displacement. Unsafe delivery of water supplies and food supplies Disruption of preexisting sanitation services such as piped water and sewage increases the risk of CD. In the longer term, an increase in vector-borne disease occurs because of disruption of vector control efforts. Malnutrition, overcrowding, lack of basic sanitation Population Displacements When large, spontaneous or organized population movements occur, an urgent need to provide humanitarian assistance is created. Public services to large number of population, such as shelters, water, foods, fuel, toilets Food and Nutrition Food shortages in immediate aftermath may arise in 2 ways. (extended droughts) 1:Food stock destruction within the disaster area→reduce the amount of food available 2:Disruption of distribution system→hardly access to food Food shortages cause nutritional problems. Nutritional condition depends on the populations, especially of vulnerable groups. Water Supply and Sanitation Drinking water supply and sewerage systems are particularly vulnerable to natural disaster. Disruptions in them pose to a serious health risk. Deficiencies in established amounts and quality of portable water and difficulties in the disposal of excreta and other wastes results in the deterioration of sanitation. That impact contributes to the conditions favorable to spread of enteric and other diseases. Mental Health Anxiety, neuroses, and depression are not major. Family and neighbors in rural/traditional societies can deal with them temporarily. Wherever possible, efforts should be made to preserve family and community social structures. In industrialized/metropolitan areas in developing countries, mental health problems are reported to be significant during long-term rehabilitation and reconstruction during the reestablishing phase. Damage to the Health Infrastructures Natural disasters can cause serious damage to health facilities and water supply and sewage systems, which have a direct impact on the health of the population dependent on these services. WHO defines Disaster Act of nature (natural disaster) earthquake, Tsunami, epidemic of infectious diseases volcanic eruption, landslide, high winds, flash floods, destructive winds, drought Act of man made(man made disaster) Explosion of nuclear power, manufacturing industries Fire, transport accidents, War, bombs Displacement Complex emergencies(armed conflict) Preparedness of Disasters Predictable Hazard Unpredictable Hazard Disaster may mean a threaten serious or great enough to justify emergency aid, in which extensive material damage is followed by tragic losses of human life, and large number of victims whose injuries are invariable serious. Health problems related to the type of Disaster Immediate health problems are related to the type of Disasters. Short-term effects (deaths, severe injuries, risk of communicable diseases, damages to health facilities and water systems, foods storage) depend on the type of Disaster and their severities. Earthquakes (Eq) The toll depends mostly on 3 factors. 1:housing type Built of adobe / of wood-frame 2:time of day at which Eq occurs Night time / day time (in urban areas) 3:population density Large variations within disaster-affected areas Distance from the epicenter Lethality: fit adults <small children, elderly Floods Slow-onset flooding causes limited immediate morbidity and mortality. Traumatic injuries caused by flood are few, require limited medical attention. However, they have the potential to spark communicable disease outbreaks because of the interruption of basic public health services. Volcanoes Volcanic eruptions affect the population and infrastructure in many ways. Burns:super-heated ash, gases, magmas Crush-type injuries:falling rocks Respiratory distress:breathing the gases and fumes Contamination of the environment (air, water, food) with volcanic ash disrupts environ- mental health conditions. Landslides Landslides have become an increasingly common disaster, because of Intense deforestation, soil erosion, construction of human settlements in landslide-prone area (in both urban and rural area). Rain brought by typhoon triggers landslides. IN general, landslide causes high mortality, although injuries are few. Severely damaged or destroyed health structures including water systems are limited. Many mistaken assumptions are associated with the impact of Disaster. Please keep them (the realities of natural disasters) in your mind,. Should be familiar with the following realities. Foreign medical volunteers with any kind of medical background are needed. True/False? The local population almost always covers immediate lifesaving needs. Only medical personnel with skills that are not available in the affected country may needed. Epidemics and plagues are inevitable after every disaster. True/False ? Epidemics do not spontaneously occur after disaster. Dead bodies will not lead to the catastrophic outbreaks of exotic diseases. The key to preventing disease is to improve sanitary conditions and educate the public. Disasters bring out the worst in human behavior (looting, rioting). True/False ? Although isolated cases of antisocial behavior exist, most people respond spontaneously and generously. 海外のメディアが今回の日本人を patient（辛抱強い） tolerant（寛容な） restrain（抑制的） と絶賛 no looting（略奪） no rioting（暴動）なし The affected population is too shocked and hopeless to take responsibility for their survival. True/False ? On the contrary, During an emergency, the thousands of volunteers who spontaneously united to sift through the rubble in search of victims after the disaster. Disasters are random killers. True/False ? Disaster strike hardest at the most vulnerable groups. The poor, especially women, children, and the elderly. Things are back to normal within a few weeks. True/False ? The effects of a disaster last a long time. Disaster-affected areas deplete much of their financial and material resources in the immediate post-impact phase. Successful relief programs gear their operations to the fact that international interest wanes as needs and shortages become more pressing. Technical Health Programs In Disaster, the health sector is responsible for treatment of casualties epidemiologic surveillance disease control basic sanitation and sanitary engineering oversight of health care in camps or temporary settlements for displaced persons (refugees) training logistic resources and support simulation exercises Treatment of Casualties Prehospital and hospital plans for treating casualties are essential in health services. Prehospital:focused on search and rescue of victim The injured are identified/tagged at the disaster site, classified according to the priority for treatment(Triage) →transfer to hospital Hospital:focused on emergency treatment, skill training,information Backup systems for communication, power, water supply, transportation Identification of Bodies Identification of bodies requires careful coordination with forensic medicine departments. The health sector should develop protocols for the identification and conservation of cadavers, death certification, local and international transport. Mass casualty management Prehospital emergency care Search, Rescue(SAR) and First Aid Most immediate help will come from uninjured survivors. Field care Triage (Red, Yellow, Green, Black) Triage consists of rapidly classifying the injured on the basis of severity of their injuries, the likelihood of their survival with prompt medical intervention. Tagging Diagnosis, initial treatment Risk of outbreaks following Disaster Disasters may increase the risk of preventable diseases due to adverse changes. 1:Population density 2:Population displacement 3:Disruption and contamination of water supply and sanitation services 4:Disruption of public health programs 5:Ecological changes that favor breeding of vectors 6:Displacement of domestic and wild animals 7:Provision of emergency food, water, and shelter in disaster situations Principles of prevention, controlling Communicable Dis Implement as soon as possible, public health measures to reduce the risk of disease transmission Organize a reliable disease reporting system to identify outbreaks and promptly initiate control measures Investigate all reports of disease outbreaks rapidly Early clarification of the situation Environmental Health Management Priority areas for intervention Temporary settlements often create areas of extremely high population density where suitable services may be absent. Lack of water and basic sanitation facilities lowers the existing level of hygiene and that increases the risk of communicable diseases. Priority environmental health services Ensuring that there are adequate amounts of Safe drinking water Basic sanitation facilities Disposal of excreta (emergency latrines,toilets, ) Wastewater Solid wastes Shelter Providing food protection measures Mass distribution of Disinfectants Environmental Health Management Water supply The first priority for ensuring water quality in emergency situation is chlorination (A minimum free residual chlorine level of 0.7mg/dl) Alternative water sources Deep groundwater, spring water, rain water, surface water Food safety and food supplies Environmental Health Management Basic sanitation and personal hygiene Ensuring the sanitary disposal of excreta Latrines, toilets (water), lime should be used People should bury their excreta Water supplies Basic hand washing, cleaning, bathing Avoid overcrowding in sleeping quarters Launch education campaign on hygiene Environmental Health Management Vector Control Vector control measures should be associated with other health measures, such as .......…. Burial of the dead Dead bodies represent a delicate social problem. Burial is simplest and best method, if acceptable. Mass cremation requires large amounts of fuel. Public information and the media Exercise Prepare the post-disaster “disease surveillance daily report” (syndrome-based surveillance system) Imagine the situation as follows: Flash floods occurred at the rural area in Cambodia in rainy season. Over 3,000 farmers and their families have to move to the temporary evacuation center. You are the chief in charge of the health post (Nurse section). Overcrowded, not enough sufficient safe water and foods, 2 doctor from UK, 8 nurses and 20 health personnel (speak both local language and English) in the this center.
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