Transcript No Slide Title

3.3
EMERGENCY
HEALTH
PROBLEMS
AFTER
DISASTERS
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OFDA photo
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PROBLEM 1: Disaster displaced
populations, especially children, are
particularly susceptible to five killer
diseases
(< 5 years of age - 175 deaths)
Malnutrition
23%
9%
ARI/Pneumonia
25%
Other
22%
10%
11%
Measles
Malaria
Major Reported Causes of Death
Children <5 Years, Refugee-Hosting
Areas
9 Districts, July 1990
Diarrhea
Source: UNHCR, MSF, ARC, IRC monthly report
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InterWorks/UNHCR
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Cause of Death of those age >4
IRC Kelamie 2000
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Misconception about
disasters, dead bodies
and epidemics:
Dead bodies from disasters
do not introduce new
epidemics. Rather, the poor
response afterwards often
results in crowded, unclean,
and unsustainable human
environments, that allow
existing diseases to flourish.
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BUT NOT ALWAYS - CONSIDER THESE
CASES...
NO excess mortality from
communicable diseases
Earthquakes in Turkey
n Floods in Mozambique
n Earthquake in El Salvador
n Hurricane Mitch
n World Trade Center Attack
n Papua New Guinea tsunami
n
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Cancer 3%
Pneumonia 3%
Cardiovascular 10%
Other 16%
Physical Trauma
e.g. violence
Cause of Death all ages
Sarajevo, Bosnia 1992-93 MSF
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Problem 2: Managers
and health specialists
do not adequately
understand the overall
health situation of
large, moving or
displaced populations.
Curative, clinical care is
believed by many to be the
first and dominant priority
in all emergencies. It’s
not. An analysis of the
overall situation will
provide insight into
priority areas.
UNHCR 7photo
Problem 3: Other key sectors are not adequately
addressed, resulting in serious public health
threats ,ultimately requiring curative health
response
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UNHCR photo/R. Darolle: Kao I Dang refugee camp, 1983
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Problem 4:
Diarrheas
have
traditionally
become
deadly in
mass
displacement
scenarios.
Is this still
true today?
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Haiti, 2010 post-earthquake epidemic
UNHCR photo, H.J. Davies, - Cholera and
other water-borne diseases claimed up to
3,000 live a day in late July 1994, Goma,
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Zaire
What is a diarrhea?
• It is difficult to identify the specific pathogen,
which could be any number of viruses,
bacteria or functional (or genetic)
abnormalities.
• Field operations typically use an operational
definition of 3 or more watery stools per
day
• Note: most rural young children in most
poor countries have diarrhea 20 or more
times per year.
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diarrhea
dysentery
measles
leishmaniasis
skin
other
MCH clinic reporting, Children
Kabul Afghanistan 1997
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Dysentery:
3 or more liquid stools
per day with blood
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Faryab Province, Afghanistan 2001
Famine and IDP by Save US
CMR of 2.6/10,000/day reported
measles
dysentery
ARI
diarrhea
other
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Faryab Province, Afghanistan 2001
Famine and IDP by Save US
CMR of 2.6/10,000/day reported
Malnutrition
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measles
dysentery
ARI
diarrhea
other
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Cholera
• Severe profuse watery
diarrhea with or without
vomiting
• Will kill quickly if not
properly addressed…
rehydration
• 1 out of 10 infections
becomes a case.
MSF photo
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• 1 out of 10 cases may
die.
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IV drip treatment of cholera victims at a refugee camp in Mozambique.
[Medecins Sans Frontiers/Doctors Without Borders photo]
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Problem 5: Lack of organization in health
programs and lack of communication with
other sectors and among agencies results in
imminent health threats.
Malnutrition, resulting from lack of adequate food, water and
sanitation ultimately results in the need for curative medical response
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Problem 6: Lack of consultation with the affected
population—and women in particular—results in
health services not reaching those in need and
corresponding negative health consequences
BBC photo
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Problem 7: Overcrowding and lack of
vaccination coverage result in lifethreatening epidemic outbreaks of
otherwise easily controlled diseases
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Jalozai refugee camp , Aug. 2001
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Problem 8: Health (and other) programs
begin too late.
epidemiologic survey in the Gode district of Ethiopia, the center of the famine in the Somali region that began in 1999,
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“In this epidemiologic survey in the Gode district of
Ethiopia, the center of the famine in the Somali region
that began in 1999, Salama and colleagues found that
most of the 293 deaths during the famine were due to
wasting and communicable diseases, including 47
potentially preventable measles-related deaths
among children aged 14 years or younger.
Approximately 77% of the deaths occurred before the
major humanitarian relief interventions began in
April/May 2000.”
From: JAMA Vol. 286 No. 5, August 1, 2001
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Problem 9: Delayed implementation of
priority health measures, including
surveillance, results in excess morbidity
and mortality – especially among children
under 5.
MSF photo – cholera ward - Bangladesh
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PROBLEM 10: Inappropriate or inadequate
health programs result in higher than
necessary rates of morbidity and mortality
Deaths/10,000/day
25
All ages
Children <5
20
15
10
5
0
3/29- 4/12
4/13- 4/26
4/27- 5/9
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Source: enquete communautaire camp de Zacku: CDC, UNHCR, US Navy,IRC
5/10- 5/24
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60 people have died in a population of 20,000 in the
last three months. What is the death rate, and what
does it mean?
OK
60 (deaths) x 10,000
90 (days) x 20,000 (total pop.)
= 0.33
On further analysis of the data, 53 of these deaths were
children under age 5, how would you report this finding
and what does it tell you?
53 (deaths) x 10,000
90 (days) x (total pop. under 5)
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This is the age profile of the population
TOTAL POPULATION IS 20,000
+13% < 5
+12% 5 - < 15
+15% 15 - < 20
+52% 20- < 60
+ 8% 60 +
= 2,600 people
= 2,400 people
= 3,000 people
=10,400 people
= 1,600 people
= 100%
=20,000 people
How do you determine the <5 MR?
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53 (deaths of children<5) x 10,000
90 (days) x (2,600 children<5)
= 2.3
What types of bias may be present in the CMR and <5 MR?
How might thes biases be addressed? How much
assessment detail is needed in emergency response
situations where time is of the essence?
Now review the chart or CMRs
around the world on page 311 of
the 2011 Sphere handbook. What
does
the chart tell you?
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CONCLUSION:
• Health problems vary with disaster type and
cause.
• For emergency settlements in crowded
conditions, pubic health concerns relate
primarily to epidemic disease outbreaks.
• Failure to meet standards in food, nutrition,
shelter, water and sanitation sectors leads to
excess morbidity and mortality.
• For the health system to keep up in such
circumstances, practitioners must fully involve
the population, be professional,
knowledgeable, supported, and coordinated.
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