Earthquake and medical complications

Natural disasters—taking a longer term view
The Lancet
The Lancet, Volume 377, Issue 9764, Page 439, 5 February 2011
According to the Centre for Research on the Epidemiology of Disasters (CRED),
earthquakes, floods, landslides, and extreme weather conditions made 2010 the
deadliest year in the past two decades. Some 373 natural disasters killed almost
300 000 people in 2010, affecting nearly 207 million others, and costing nearly
US$110 billion in economic losses.
CRED’s data look at the top ten global disasters of 2010. For the first time in
decades, the Americas head the list of the worst affected continents, where one
single event, the Haiti earthquake, was responsible for 75% of total deaths.
Europe was next, accounting for a fifth of the year’s total deaths from
disasters brought on by the Russian heatwave. Asia represented 4•7% of total
mortality caused by disasters that year, and remained the most affected
continent; 89% of those harmed lived in Asia. Earthquakes, flood, and landslides
killed 6424 people in China. An earthquake killed 530 people in Indonesia, and
nearly 2000 people were killed by floods in Pakistan that submerged one-fifth of
the land mass.
CRED’s data for economic losses show a different and somewhat misleading
picture. Richer countries post higher economic losses than do poorer ones.
Because these statistics are mainly drawn from insurance or government
compensation schemes, higher property values and better insurance penetration,
these richer countries have high loss estimates. Human lives and disabilities in
poor countries are not valued in these calculations, and so Haiti drops from
rank 1 in terms of human impact to rank 4 in economic impact, and Chile (a
medium—high economy) rises from rank 7 to 1, respectively.
That disasters mainly affect the poorest populations is well known. But
understanding the impact of a natural disaster on human lives and livelihoods is
limited, which experts believe is why governments are not proactive about
disaster risk reduction and mitigation. There are no rigorous epidemiological
studies or data about the risk factors of death, injury, and disease. For
example, earthquakes kill a lot of people, but evidence on patterns of
mortality—who has died, when (on impact or 5 days later because of a lack of
care), and where (inside the house or outside)—will give insights into risk
factors that are actionable and help target high-risk groups. Furthermore, there
is an urgent need for health impact studies of disasters in the medium term. To
date, disaster preparedness and prevention programmes remain in the domain of
assumptions instead of evidence. Political will, whether it is local
municipalities or global donors, can only change if faced with convincing
statistics from the field. Just stating that the poor are dying is no longer
enough.
2010 was an exceptionally challenging year for the international aid community
with the catastrophic events that took place in Haiti and Pakistan. 1 year on,
Haiti is still in disarray with over 1 million people displaced and grappling
with a severe cholera outbreak. In Pakistan, 6 months on, the situation is also
fragile, with millions of people at serious risk of life-threatening illnesses,
many still homeless, and with food and water in short supply. Lessons to emerge
from the responses are the need for leadership and to get experienced people
into key roles immediately after disaster strikes. There should be a system for
certifying international non-governmental organisations: to ensure coordination
of their activities and that they bring in solutions that are contextually
relevant. A similar certification process for doctors and nurses, and a standard
central dispatching system for patients who need trauma surgery or for immediate
post-operative care, should also be set up. Pre-established relief packages
should be deployed to countries prone to disasters, and there should be a review
of disease control and surveillance on the basis of evidence from the field.
Both Haiti and Pakistan point to the need to take a long-term view of disaster
response and risk management when it comes to health. Clearly, large-scale
emergencies have a negative impact on efforts to meet wider development goals.
Not only are resources diverted away from taking steps to meet the goals, but
many thousands of people are also plunged into new crises by natural disasters.
UN officials warn that natural disasters will be more frequent in coming years
if unplanned urbanisation and environmental degradation continue, and there are
increases in weather-related events that include climate change. Treating
disasters as singular events with a quick fix is no longer tenable. The future
emergency response needs to be better aligned with a longer term perspective—a
development perspective, looking at key socioeconomic investments and
infrastructure and preparedness and planning for disasters—if more lives are to
be saved.