Transcript DISASTER MANAGEMENT AND PUBLIC HEALTH EXPERIENCE IN THE AFTERMATH OF THE EARTHQUAKE AT BHUJ IN INDIA Dr HS Ratti, MD India.

DISASTER MANAGEMENT
AND PUBLIC HEALTH
EXPERIENCE IN THE
AFTERMATH OF THE
EARTHQUAKE AT BHUJ
IN INDIA
Dr HS Ratti, MD
India
DATE
1819 JUN 16
1869 JAN 10
1885 MAY 30
1897 JUN 12
1905 APR 04
1918 JUL 08
1930 JUL 02
1934JAN 15
1941 JUN 26
1943 OCT 23
1950 AUG 15
1956 JUL 21
1967 DEC 10
1975 JAN 19
1988 AUG 06
1988 AUG 21
LOCATION
MAGNITUDE
KUTCH,GUJARAT
8.0
NEAR CACHAR, ASSAM
7.5
SOPOR, J&K
7.0
SHILLONGPLATEAU
8.7
KANGRA, H.P
8.0
SRIMANGAL, ASSAM
7.6
DHUBRI, ASSAM
7.1
BIHAR-NEPALBORDER
8.3
ANDAMAN ISLANDS
8.1
ASSAM
7.2
ARUNACHAL PR – CHINA BDR
8.5
ANJAR, GUJARAT
7.0
KOYNA, MAHARASHTRA
6.5
KINNAUR, HP
6.2
MANIPUR-MYANMAR BORDER
6.6
BIHAR-NEPAL BORDER
6.4
SIGNIFICANT EARTHQUAKES IN INDIA
AND ITS NEIGHBOURHOOD (1801 - 2000)
DATE
LOCATION
1991 OCT 20
MAGNITUDE DEATH
UTTARKASHI, UP HILLS
1993 SEP 30
LATUR-
1997 MAY 22
JABALPUR,MP
1999 MAR 29 CHAMOLI DIST, UP
6.6
6.3
INJURED
769
7601
6.0
39
6.8
103
16000
ANTICIPATED PUBLIC HEALTH
PROBLEMS IN DISASTERS
1 Disruption of Water supply and Sanitation
2 Large scale migration
3 Overcrowding due to emergency housing situations with
poor personal hygiene
4 Mass feeding without adequate food handling, storage
and sanitary facilities
5 Disposal of Dead Bodies and Caracas
6 Rodent and Stray dog/animal problems
7 Relaxation of sterilization precautions and emergency
use of unscreened blood
8 Psycho-social and Mental health problems
COMMUNICABLE DISEASES HAVING DISASTER
IMPLICATIONS (HAVING POTENTIAL FOR OUTBREAK)
1.Amoebiasis
2.Camplyobacter Enteristis
3.Chicken Pox
4.Cholera
5.Coccidiomycosis
6. Dengue fever
14. Leptospirosis
15. Malaria
16. Measles
17. Meningitis
18. Pertusis
7.Diptheria
19. Plague
8.E. Coli Diarrhoea
20. Pnuemococcal Pneumonias
9.Food Poisoning
21. Rabies
10.Rotavirus Enteritis
22. Relapsing Fever
11.Hepatitis A, B & E
23. Salmonellosis
12.Hanta Virus Disease
24. Scabies
13.Influenzae
25. Typhoid Fever
26 Jan 2001 at 0856 AM
(IST), Bhuj in western India
and its surrounding areas
were struck with severe
earthquake, measuring 7.9 on
the Richter scale
CRATER FORMED AT THE
EPICENTRE AT DHORI
LINEAR CRACK AT THE
EPICENTRE AT DHORI
LAVA LIKE
MATERIAL
SPROUTED
AT THE
EPICENTRE
DESTRUCTION LEFT BEHIND BY THE EARTHQUAKE
Mortality and Morbidity
• Dead
19727
• Injured
1,66,000
• Homeless
6,00,000
• House Destruction total :
3,48,000
• House Destruction partial :
8,44,000
• Total cattle Killed :
20,000
• Direct Estimated Economic Loss :USD 1.3 bn
• Large scale
migration of
inhabitants
• Large scale scale
influx of relief
workers & material
Relief Agencies at work
•
•
•
•
•
•
•
International NGOs
: 55
National /Local NGOs
: 26
Government Bodies
:8
Donor Governments
:18
Inter Governmental Organisations :8
Red Cross and Red Cresent
:6
Total Organisations (2 weeks)
:125
• Immediate 48-72 hrs
Relief and Rescue
provided by Indian
Army Teams and the
Indian Army Hospital
• 12000 surgical
operations
performed in
makeshift Military
Hospital within first
60 hrs of the Disaster
Public Health Measures
• Situation Assessment
• Public Health Measures
– Water Borne disease
– Air Borne infections
– Vector borne diseases
– Biomedical wastes
– Disease Surveillance
– Dead Bodies and Animal Caracas Disposal
– Disinfecting of Rescue Sites and Teams
– Mental Health
CLIMATIC CONDITIONS PREVAILING IN BHUJ
IN FIRST WEEK OF FEB 2001
Day Time
Night Time
RH
Rainfall
Max
330 C
190 C
72
Nil
Min
220 C
090 C
61
Avg Temp 210C
Gujarat State has
experienced Drought
Conditions
since 1998
Water Borne disease
• Threat potential
– Breakdown of distributed piped water
supplies and water requirement being met
from alternate sources
– Drinking water available only from 4 to 5
deep bore wells scattered over the whole
town and nearby villages in the Public
Health Engineering Department.
– Drinking water is highly salty and at places
turbid (due to earthquake).
– The water is collected by water truck/water
bowsers/tankers and distributed manually
Water Borne disease
• Intervention
– The bore well water is collected in sump.
– Flocculation and sedimentation in the sump was
carried using Alum for a period of atleast 4 hours
– It is followed by super chlorinating at 2 ppm with
liquid chlorine and/or bleaching powder with a
contact period of minimum 20 minutes
– All water bowsers/tankers leaving the water point
were checked for free chlorine levels and due
records were kept.
Water Borne disease
• Outcome
– 70 to 75 percent of population was getting
chlorinated water supply.
– A 8000 litre desalination plant received as gift
from USAID was installed for exclusive issue of
drinking water.
–There were no cases of Gastro Intestinal
diseases among population in 3 week post
disaster period.
–A close monitoring has been instituted
combined with disease surveillance
Air Borne disease
• Threat potential
– All pers and families living in tentage and
makeshift arrangements
– Inadequate supplies of tentage resulting in
overcrowding by a factor of 80 to 100 percent.
– Sharp and high difference in max and min temp
(max daytime temp of 34 to 36 degrees centrigade
while min night temp was 8 degrees centigrade)
– Season ideal for Chicken pox, measles and
meningitis outbreaks
– Potential of outbreak of Bubonic plague was kept
in mind in view of earthquake disaster
• Intervention
Air Borne disease
– Health education campaign was undertaken to
ensure that there was minimal over crowding in
tentage accommodation. A minimum distance of 3
feet was advocated
– To adopt a head-foot alternate bed positions
– Adequate ventilation of tentage and exposure to
sun during daytime was adovacated
– Provision of adequate warm clothing
– Field and Hospital based Passive Disease
surveillance
– Active surveillance by random interviews was
carried out in select areas of high density. Every
day, a new area was visited. Health advice was
given.
Air Borne disease
• Outcome
– There were 4 cases (all adult males) of chicken
pox reported between 7 to 8 Feb in military areas
and 31 cases among civil population in
samkhayali village near Bachao. Of these, 28
were children under 12 years of age and 3 adults
– Outbreak control measures included
segregation and symptomatic treatment of the
affected individuals
– All cases recovered and no secondary outbreak
of communicable diseases was reported in
military and civil areas till 3 weeks after last case
Vector Borne disease
• Threat perception
– No piped distribution of water supply
leading to places with water point
collection
– Inadequate disposal of liquid and solid
wastes leading to fly nuisance
– Inadequate disposal of Bio Medical
waste
Vector Borne disease
Intervention
– Spraying operations using 0.1 % NUVAN (Dicholorvos)
solution in the areas where solid waste were disposed
– Daily sprinkle of Lime Slaked powder over and around
the Deep Trench/Shallow Trench latrines used for
excreta disposal in temperory shelters put up for living
– ‘Smoking’ of the Deep trench latrines to prevent and fly
breeding
– Spray water collection pockets with anti larval
measures - Baytex 1000 Conc and/or Baytex granules
or Abate (Temephos 0.5%)
– Space spraying of tentage accommodation with
Baygon and /or Malathion 50 % EC (in 0.5 % solution)
Bio Medical Waste
• Large quantity of Biomedical waste was generated in
the areas in military hospital and other places in whole
of district of Bhuj following disaster.
• No incineration facilities are available except in the
military hospital where rudimentary and sufficient
facilities are available only for routine workload
• The waste was segregated into open pits at a distance
from the hospital and burnt in the beehive incinerator
over a period of 7days
• Other non biodegradable waste like plastics, IV Sets,
were disposed by deep burial in open ground
• Biological medical waste generated in other areas
including animal dead was strewn all around in Bhuj
district and posed a potential public health problem
Disease Surveillance
• Active Disease
surveillance in 10 relief
centres were
established in and
around Talukas of Bhuj
district - Khavda, Anjar,
Baccaho (2 centers),
Samkhyali, Ratanpol,
Modvadar, Dhori,
Dharan and Mandvi.
• Passive Disease
surveillance launched
in consultation with
WHO Teams and the
State Health authorities
•Each relief centre had a
team of one Medical
Officer and Two Nursing
Assistant. Besides,
additional Mobile Teams
from each centre were
sent out daily to cover
different villages.
•No mass immunisation
was recommended.
However, UNICEF
promoted mass
vaccination against
measles for all children 9
mths - 5 yrs was
undertaken in the the
Kutch areas by the state
health authorities
Disinfection of Rescue Sites and Teams
• Personal Protective
Measures
– Gloves, Face Masks and
Head Protection
• Disinfecting The Dead
Bodies with 40%
Formalisn and 10 %
Creosol Solution
• Deodourisation of the
work are at the relief
site
MENTAL HEALTH
•Acute Post Stress Disorder
•In need of Post Traumatic
Counseling
A much relieved lady
rescued after 96 hours.
REHABLITAION & RECONSTRUCTION
First steps towards future ?