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					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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