Scope of the Problem

The incidence of natural disasters, both natural and technological, is increasing worldwide.^12,33 During the decade from 1997 to 2006, 6,806 natural disasters, not including wars, conflict-related famines, and epidemics, were reported to have killed 1.2 million people worldwide, adversely affected 2.7 billion persons, and resulted in property damage exceeding $800 billion²³ (Video 86-2, online).

Natural disasters constituted 54% of these events. The most frequent types of disasters were floods, 32%; transport accidents, 28%; and windstorms, 10%. In particular, meteorologic hazards affect an increasing number of people and cause increasingly large economic losses.⁴⁰ This is perhaps related to climate change. Between 1970 and 1999, victims of meteorologic hazards represented 90% of the world’s disaster-related fatalities.¹²

The terminology of storms is complex. A storm is any disturbed state of an astronomic body’s atmosphere, especially affecting its surface, and strongly implies severe weather. It may be marked by powerful wind, thunder, and lightning (a thunderstorm); heavy precipitation such as ice (an ice storm); or wind transporting a substance through the atmosphere as in a dust storm, snowstorm, or hailstorm. A cyclone is a weather phenomenon featuring a central region of low pressure surrounded by air flowing in an inward spiral and generating maximum sustained wind speeds of 119.1 km/hr (74 mph) or greater. Cyclones that form over warm water are known as tropical cyclones. A tropical cyclone is referred to as a “hurricane” in the Atlantic basin and the western coast of Mexico. It is called a “typhoon” in the western Pacific and “cyclone” in the Indian Ocean and Australasia.²⁸ Tornadoes are different from cyclones; they generally form over land in areas of large vertical temperature gradients and are smaller and briefer in duration. When tropical cyclones make landfall, they sometimes give rise to tornadoes.

The world’s poor are disproportionately affected by disaster, such that the most vulnerable and marginalized people in poverty-stricken nations bear the brunt.*

Table 86-2 shows the major natural disasters that occurred from 1970 to 2010 and the number of fatalities associated with each event. Two separate natural disasters in May 2008 resulted in a death toll equivalent to 21% of the total for the entire previous decade. On May 2, Cyclone Nargis struck Myanmar, causing catastrophic destruction and at least 146,000 fatalities.⁴ Ten days later, an earthquake with a magnitude of 7.9 on the Richter scale struck Sichuan province in central China, killing an estimated 86,000 people and leaving approximately 4.8 million persons homeless.³⁵

TABLE 86-2 Selected Natural Disasters, 1970 to 2010

Public Health Impact of Natural Disasters

Populations at risk for disasters face a range of hazards within a nearly infinite set of scenarios. This unpredictability is poorly suited to scenario-based approaches to risk management.²⁰ Although the hazards that cause disasters may vary greatly, the potential public health consequences and subsequent public health and medical needs of the at-risk population do not.^15,24,25 For example, floods, hurricanes, and earthquakes all displace people from their homes. These hazards require the same sheltering capability, with only minor adjustments based on the rapidity of onset, scale, duration, location, and intensity. Regardless of the hazard, disasters can be seen as causing 15 public health consequences that are addressed by 32 categories of public health and medical capabilities.²⁵

By using an all-hazard, capability-based approach, communities prepare for and respond to disasters by applying their own capabilities to any hazard. Table 86-3 lists consequences and public health capabilities that are most commonly addressed in a disaster response. The range of public health consequences actually varies little among disaster hazards. Public health interventions may vary more according to the severity of disaster consequences and impact of the disaster, rather than according to the specific hazard itself. Table 86-4 summarizes the relative public health impacts of various types of natural disasters. Table 86-5 illustrates common public health interventions applied across many disaster types, regardless of the specific hazard or scenario.

TABLE 86-3 Key Components of Natural Disaster Risk Management

TABLE 86-4 Short-Term Effects of Major Natural Disasters

TABLE 86-5 Public Health Consequences and Capabilities Associated With All Disasters

Health Care Needs in Specific Natural Disasters

All natural disasters can markedly affect the ability of the population to maintain and access adequate shelter, water, sanitation, hygiene, health care, nutrition, security, public services, and utilities to maintain acceptable health during a disaster event. These factors have significant influence on morbidity following a disaster. Natural disasters that can cause substantial property damage, economic dislocation, and medical problems include earthquakes and associated phenomena, volcanic eruptions, and extreme weather incidents, such as heat waves and blizzards. Accounts of morbidity and mortality recorded after previous disasters can predict the medical care needs of future disaster victims and provide a foundation for disaster response planning. Geophysical disasters, as compared with meteorologic disasters, tend to create higher rates of injuries. Geophysical disasters also tend to occur with less opportunity for advance warning, as compared with most meteorologic disasters. Although one of the authors was interviewed more than 20 years ago, the old adage, “The Golden 24 Hours” of search and rescue still pertains; 85% to 95% of live rescues are made during the first 24 to 48 hours after an earthquake. Beyond that, survivability drops precipitously (Video 86-3, online).

Injuries are the leading cause of death in all natural disasters. For geophysical disasters, burns, asphyxia, and other forms of blunt and penetrating trauma are the main causes of death (Figure 86-5).

FIGURE 86-5 The author (EKN) amid the total devastation of the city of Leninakan following the December 7, 1988, earthquake in the Soviet Republic of Armenia.

(Courtesy Eric K. Noji.)

For cyclones, hurricanes, typhoons, and floods, the main cause of death is drowning (Figure 86-6). In the case of tropical cyclones, the storm surge remains the primary cause of mortality, especially in low-income nations (Figure 86-7). Most injuries, such as nail puncture wounds, lacerations, falls, burns, electrocutions, and carbon monoxide poisonings, are sustained during the disaster recovery clean-up phase of the disaster. The main cause of death in tornadoes and landslides is traumatic injury sustained during disaster impact. The main causes of death caused by heat waves are heat illness and exacerbations of chronic respiratory and cardiovascular diseases. Drought-related deaths are generally mediated by agricultural, economic, and medical effects, such as malnutrition, poverty, poor sanitation and hygiene, unsafe water, infectious diseases, and conflict. The main causes of death during wildfires are injuries, mostly burns and smoke inhalation. The public health impact of wildfires may include burn injuries, exacerbations of chronic obstructive pulmonary disease and asthma, and temporary population displacement that results in a need for humanitarian assistance.

FIGURE 86-6 Florence, South Carolina, September 6, 2004. A car floating in a flooded road. The flooding is a result of Hurricane Frances.

(Courtesy U.S. Federal Emergency Management Agency.)

FIGURE 86-7 The December 26, 2004, tsunami in South Asia. Incoming waves rushed in quickly with great force and volume, leading to the deaths of nearly 400,000 people across 15 nations.

(Courtesy U.S. Navy.)

Infectious disease epidemics following natural disasters are rare and differ according to the level of economic development of the affected nation. Geophysical disasters are almost never associated with epidemics of communicable disease unless followed by large-scale population displacement and crowding as seen in Haiti in the fall of 2010 (Figure 86-8). Meteorologic disasters are only rarely associated with epidemics of communicable disease, mostly in low-income nations. Behavioral health effects are among the most debilitating long-term outcomes of natural disasters.

FIGURE 86-8 Over 2 million persons became homeless as a result of the January 12, 2010, earthquake in Haiti. One year later, hundreds of thousands continue to live in displaced person encampments, living in shelters consisting of little more than plastic sheeting.

(Courtesy U.S. Agency for International Development.)

Global changes, such as climate change and stratospheric ozone depletion, degradation, and desertification, have a significant impact on human health. They affect health both directly and indirectly, as for example through the results of extreme weather events. Biodiversity systems are areas throughout the world where the major life forms that sustain our global “biology” are found. It is in these areas where the large majority of the crucial 1500 vascular plant species, and at least 70% of original vertebrates, reside and define the foundation for sustaining the “public health” of the planet. Biodiversity hot spots, of which there are 34, are regions with a uniquely rich level of endemic species that also are most threatened. Dense human habitation tends to occur near biodiversity hot spots, most of which are large forests or located in the tropics.

Tragically, 80% of natural disasters, resulting in greater than 100,000 deaths during the last three decades occurred in 23 of the 34 most biologically diverse and threatened places. Central China is an example, where only 6% of land is arable, packed between and sustained by the Yangtze and Yellow Rivers. Poor land-use management, including large-scale deforestation, has severely degraded the once-fertile soil. In the Middle East, ambitious plans by Turkey and Syria to divert the rivers from their origins with dams and hydroelectric plants may prove to be the final blow to Iraq’s fragile agricultural economy. Iraq’s Minister of the Environment, Narmin Othman, claimed in September 2010 that environmental degradation is being intensified by an acute drought and water shortage across a country that has seen a 70% decrease in the volume of water flowing through the Tigris and Euphrates Rivers as they enter the country from the north. Othman emphasized, “We can no longer in good conscience call ourselves the land between the rivers. A lot of the water we are getting has first been used by Turkey and Syria for power generation. When it reaches us, it is poor quality. That water which is used for agriculture is often contaminated. We are in the midst of an unmatched environmental disaster” (interview with BBC, September 23, 2010).

Information Management Systems for Disaster Response

Over the past several years, efforts have been made to develop rapid and valid disaster damage assessment techniques. These techniques must be able to define quickly the overall effects of the disaster impact, nature and extent of the health problems, groups in the population at particular risk for adverse health events, specific health care needs of the survivors, local resources to cope with the event, and extent and effectiveness of the response to the disaster by local authorities. The Centers for Disease Control and Prevention (CDC) has developed indicators for needs assessment “quick and dirty” surveys following earthquakes, highlighting simplicity, speed of use, and operational feasibility. The techniques employed (e.g., systematic surveys, simple reporting systems) are methodologically straightforward. With suitable personnel and transport, estimates of relief needs can be quickly obtained. Problems may arise, however, with interpretation of data, particularly incomplete data, and in developing countries in which predisaster health and nutrition levels are unknown.

Related posts:

e Leave No Trace The Ethics of Wilderness Medicine Wilderness Trauma and Surgical Emergencies Wound Management Exposure to Radiation From the Sun