Transcript DISASTERS – AN INDIAN EXPERIENCE Prof. Shridhar Sharma MD, DPM, FRCPsy (London) FRANZCP(Australia), DFAPA (USA), FAMS Emeritus Professor National Academy of Medical Sciences & Institute of.

DISASTERS – AN
INDIAN EXPERIENCE
Prof. Shridhar Sharma
MD, DPM, FRCPsy (London) FRANZCP(Australia), DFAPA (USA), FAMS
Emeritus Professor
National Academy of Medical Sciences &
Institute of Human Behaviour & Allied Sciences, Delhi-110 095
• Disasters are ubiquitous but most large
scale disasters occur in cancer and tropic of
Capricorn
geographical
region
which
encompasses most of the developing
nations.
• Due to the geography and topography, India
has faced serious large scale natural
disasters like droughts, cyclones and
earthquakes.
• The available statistics also show that the
number of disasters per year is increasing
but also the number of people affected and
killed is also rising.
Major Disasters in Known History of India
SR.
Name of Event
NO.
Year
Fatalities
1.
Bengal Earthquake
1737
300,000
2.
Bengal Cyclone
1864
60,000
3.
The Great Famine of
Southern India
1876-1878
5.5 million
4.
Maharashtra Cyclone
1882
100,000
5.
The Great Indian famine 1896-1897
6.
Kangra earthquake
1905
20,000
7.
Bihar Earthquake
1934
6,000
8.
Bengal Cyclone
1970
500,000 (include Pakistan & Bangladesh)
9.
Drought
1972
200 million people affected
10. Andhra Pradesh Cyclone
1977
10,000
11. Latur Earthquake
1993
7,928 death and 30,000 injured
12. Orissa Super Cyclone
1999
10,000
13. Gujarat Earthquake
2001
25,000
14. Indian Ocean Tsunami
2004
10,749 deaths 5,640 persons missing
15. Kashmir Earthquake
2005
86000 deaths (include Kashmir & Pakistan)
1.25 million to 10 million
Natural disasters
• Earthquake: India is having a high risk towards
Earthquakes. More than 58 per cent of India’s land
area is under threat of moderate to severe seismic
hazard.
• During
the last 20 years, India has
experienced 10 major earthquakes that have
resulted in more than 35,000 deaths.
• Of the earthquake-prone areas, 12% is prone to
very severe earthquakes, 18% to severe
earthquakes and 25% to damageable earthquakes.
• The biggest quakes occur in the Andaman and
Nicobar Islands, Kutch, Himachal and the NorthEast. The Himalayan regions are particularly
prone to earthquakes.
Earthquake in Gujarat
Earthquake
Floods:
• About 30 million people are affected annually. Floods in
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the Indo–Gangetic–Brahmaputra plains are an annual
feature.
On an average, a few hundred lives are lost, millions are
rendered homeless and several hectares of crops are
damaged every year.
Nearly 75% of the total rainfall occurs over a short
monsoon season (June – September). 40 million
hectares, or 12% of Indian land, is considered prone to
floods.
Floods are a perennial phenomenon in at least 5 states Assam, Bihar, Orissa , Uttar Pradesh and West Bengal.
On account of climate change, floods have also occurred
in recent years in areas that are normally not flood prone.
In 2006, drought prone parts of Rajasthan experienced
floods.
Droughts:
• Drought is another recurrent phenomenon
which results in widespread adverse impact on
vulnerable people’s livelihoods and young
children’s nutrition status.
• About 50 million people are affected annually by
drought. Of approximately 90 million hectares of
rain-fed areas, about 40 million hectares are
prone to scanty or no rain.
• Although a slow onset emergency, and to an
extent predictable emergency, drought has
caused severe suffering in the affected areas in
recent years, including effects on poverty,
hunger, and unemployment.
Cyclones:
• About 8% of the land is vulnerable to cyclones of which
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coastal areas experience two or three tropical cyclones
of varying intensity each year.
Cyclonic activities on the east coast are more severe
than on the west coast.
The Indian continent is considered to be the worst
cyclone-affected part of the world, as a result of lowdepth ocean bed topography and coastal configuration.
The principal threat from a cyclone are in the form of
gales and strong winds; torrential rain and high tidal
waves/storm surges.
More cyclones occur in the Bay of Bengal than in
the Arabian Sea and the ratio is approximately 4:1.
An analysis of the frequency of cyclones on the east
and west coasts of India.
Landslide
• In the hilly terrain of India including the
Himalayas
and
North
East
India,
landslides have been a major and widely
spread natural disasters that often strike
life and property and occupy a position of
major concern.
• One of the worst tragedies took place
at Malpa Uttarkhand (UP) on 11th and 17th
August 1998 when nearly 380 people were
killed when massive landslides washed
away the entire village.
Avalanche
• Avalanche are river like speedy
flow of snow or ice descending
from the mountain tops.
• Avalanches are very damaging
and cause huge loss to life and
property.
• In Himalayas, avalanches are
common
Tsunami affected Indian territory
TSUNAMI
TSUNAMI
TSUNAMI
HIGH
HIGH
LOW
SCOPE
LOW
INITIAL LETHALITY
CHARACTERISTICS OF NATURAL DISASTERS:
LOW
SUDDEN
•Earthquakes
•Cyclones
•Floods
HIGH
•Famine
SLOW
• The last century has added a new ecological
dimension to the definition of a disaster.
• We then have newer man made disasters on
our hands which include chemical Disasters
like Bhopal Gas Tragedy of 1984, oil spills, air
water and soil pollution.
• Developing countries have been facing the
brunt more than the developed ones because
they have less physical and financial
resources.
• India as the second largest populated country
with 1.2 billion population has a large share of
all types of disasters.
 It is virtually impossible to prevent
most disaster.
 Nevertheless, we can forestall or
alleviate many of their worst effect by
anticipating them and by being
prepared.
 The greatest number of disasters occur
in those countries that are already most
adversely affected by ill-health and poor
economic conditions.
• DISASTER
is
a collective
responsibility
requiring
coordinated responses from
various agencies and all parts
of the society.
• Government Agencies:
1.
2.
3.
4.
Urban Development
Agriculture & Food
Health
Energy - Power
DISASTERS PRODUCE SEVERAL TYPES OF
TRAUMA. THE HEALTH CONSEQUENCES
FALL INTO VARIOUS CATEGORIES
 STARVATION
 DEATH
 WATER & POWER
 DISEASE
SUPPLY
 DISABILITY
 UNEMPLOYMENT
 DISTRESS
 ROADS –
 DISLOCATION
 DISORGANIZATION COMMUNICATION
DISASTER TRAUMA
PHYSICAL
PSYCHOLOGICAL

1.
2.
3.
4.
5.
6.
7.
Fractures
 Burns
 Injuries
 Infections

Poisoning
8.
9.
10.
11.
12.
13.
Depression
Grief
Anger
Guilt
Apathy
Fears
The “ burn-out”
syndrome
Bizarre behavior
Suicide
Bereavement
Anxiety
Alcohol abuse
Stress reactions
SOCIOECONOMIC


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
Environmental
destruction
Unemployment
Disorganization
Homelessness
APPROACHES
Rescue
Relief
Rehabilitation
Follow-up
THE PSYCHOLOGICAL RESPONSE TO DISASTER WILL
DEPEND ON THREE MAIN FACTORS:
DISASTER
MAGNITUDE
RESPONSE
VICTIM
•
THE DISASTER:
- MAGNITUDE
- SUDDENNESS
- TYPE
•THE COMMUNITY
- LEADERSHIP
- PAST EXPERIENCE
COMMUNITY
- OCCURRENCE
- LEVEL OF PREPAREDNESS
- SOCIAL SUPPORT
•THE VICTIMS:
- AGE
- LEVEL OF EDUCATION/EXPOSURE
- MARITALSTATUS
- PHYSICAL HEALTH
SPEED & DIRECTION ARE
KEY ISSUES
• The key issues are:
Quick assessment
response
Immediate
Quick Planning
Coordination
Quick Execution or action
result
Desired
KEY CONCEPTS
1. The target population
primarily normal
is
2. People do not disintegrate in
response to disaster.
3. People respond to active
interest and concern.
Traumatized individuals are resistant to
seeking treatment
So treatment must be taken to survivors.
Victims of flood, earthquakes and hurricanes
Increased Prevalence of: PTSD
Depression
which are risk factors for suicidal
thinking
suicide rate increases
need for
mental Health support after severe disasters.
• Morbidity represents a cluster of
diseases involving more than one
target organ.
• Exposure levels are difficult to
establish
• Environmental Monitoring
have limitations.
may
• Biological Monitoring may not be
feasible.
• Community as a Resource
• Need for Joint preparation
• Need to develop
• Single function but develop
Joint training
• Multidisiplinary
service
model
Joint training
• A chain is as strong as its
weakest link
GUIDELINES
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Crucial rehabilitation process.
The first objective is to get water, Food, Electricity
and Sewerage system restored plan temporary
housing up in a few weeks so that the people can
move out of the schools.
Long term housing is essential to use locally
available material that are suitable for the climate
and culture.
Getting people to build their own houses has a
two-fold purpose.
It provides the people with an income, it gets them
involved and interested in the design and
construction of their houses and this participatory
approach gets them out of the depression and
lethargy that follows trauma.
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There is a need for institutionalization of
process for learning from experiences
obtained from Disaster
Creation of information and Data clearing
house on Disaster management
Creating a knowledge centre in each
Locality
Readiness and develop strategies and
intervention.
Act on lessons learned from evidence based
research and practical experience (fire in
building lift staircases, Drowning.- Safety
ships tanks- Bhopal Gas tragedy
Longitudinal analysis of
earth quake-victims
Factor 1 - Fear anxiety-appear earlier
and decreased earlier
Factor 2 - Depression
&
Physical
symptoms appeared later &
stayed longer.
Factor 3 - Psychosocial
problems
gradually decrease as time
passed by
TABLE : COMPONENTS OF CHEMICAL
DISASTER PREPAREDNESS
PHASE
1. Hazards
ACTIVITY (BEFORE THE DISASTER)
: Identification of hazards
: Identification of vulnerabilities.
: Assessment of risk
2. Prevention : Removal of the hazard
: Selection of alternatives
: Hazard control
3. Planning
: Contingency planning
mitigation : Knowledge of rehabilitation methods
: Instituting organizational framework
TABLE : COMPONENTS OF CHEMICAL
DISASTER PREPAREDNESS
PHASE
Emergency
Follow-up
ACTIVITY (AFTER THE DISASTER)
: Accurate response
: Speed of Action
: Knowledge of chemicals(s)
: Fencing of the accident
: Diagnosis of needs
: Implementation
: Monitoring
: Feedback and adjustment
: Information transfer & storage
Therapeutic approaches in survivors of Disaster
Common Psychiatric response to Disaster:
1. Acute stress Disorder
2. Anxiety, fear and Panic
3. Depression
4. PTSD
5. Substance Abuse
6. Somatization Disorders
7. Adjustment disorder
8. Organic mental disorder, injury, toxins etc.
• Mental health personnel constitute a very valuable resource.
• They should not only be included in the design of a disaster plan
but also interacted into the disaster response team.
• Mental health care must receive special attention
and be
frequently updated for the population living in disaster prone
areas.
• A plan must be prepared for all situations.
• In order to help victims in distress, mental health specialists
must design short and long term training programs depending
on the level of knowledge and skills of the staff, and implement
them.
• In the immediate aftermath of a disaster, both health and relief
workers need a quick and flexible orientation.
• This training session must be planned before the disaster impact.
DIMENSIONS OF MENTAL HEALTH
The field of mental health includes three sets of
objectives.
• One of these has to do with mentally ill person s. For them the
objective is the restoration of health.
• A second has to do with those people who are mentally healthy but
who may become ill if they are not protected from conditions that
are conductive to mental illness, which however are not the same
for every individual. The objectives for those persons is
prevention.
• The third objective has to do with the upgrading of mental health of
normal persons, quite apart from any question of disease or
infirmity. This is positive mental health. It consists in the
protection and development at all levels, of human society of
secure, affectionate and satisfying human relationships and in the
reduction of hostile tensions in persons and groups.
HOPE: INDIA CAN DEAL
WITH THE CRISIS
India had enough experience in dealing with
natural disasters.
 The lessons that we learnt from the Orissa
cyclone of 2000, the Gujarat earthquake of
2001 and other disasters have helped us
effect a paradigm shift in our approach to
disaster management proceeding from the
conviction that development cannot be
sustainable unless disaster mitigation is built
into the development process at all levels.

Strategic Plan
• Need to build a national hub
to share and learn and to
create a critical mass of
institutions, trainers and
trained professionals.
Every calamity presents
an opportunity to equip
themselves to face with
greater confidence and
competence,
similar
challenges in the future.
• Disasters disrupt progress and destroy the
outcome of developmental efforts over several
years, often pushing nations in quest for progress
back by several decades.
• Thus, efficient reduction of disaster risks, rather
than mere response to their occurrence, has in
recent times, received increased attention both
within India and abroad.
• With a vision to build a safe and disaster resilient
India, the Government has adopted a holistic,
proactive, multi-hazard oriented and technology
driven strategy by promoting a culture of
prevention,
mitigation,
preparedness
and
response.
THANK
YOU