Environmental Health during Disasters Presenter Shib Sekhar Datta

Environmental Health during Disasters Presenter: Shib Sekhar Datta Moderator: Prof. A M Mehendale

Framework of Presentation • Rationale • Importance of environmental health during disasters • Technical Aspects § § § § § Shelter and emergency settlements Water supply Sanitation Food safety Vector and pest control Control of communicable diseases and prevention of epidemics Special incidents: chemical and radiation emergencies Mortuary services and handling of the dead Health promotion and community participation • Integrated disaster management in India • References

Humanitarian action { Prevention Rehabilitation Preparedness Response Disaster impact Fig: The disaster management cycle { Humanitarian action Sustainable development Development

Indian sub continent has been exposed to disasters from time immemorial 57% of the land vulnerable is to Earthquakes 28% is vulnerable to Droughts 12% is vulnerable to Floods of the land is vulnerable to Cyclones 8% Susceptibility of various man made hazards

Priorities in the acute emergency phase include • Facilities for people to excrete safely and hygienically • Protecting water supplies from contamination • Minimum amount of water for drinking, cooking and personal and domestic hygiene • Ensuring people have enough water containers to collect and store water cleanly • Ensuring that people have soap for hand washing • Ensuring that people have sufficient cooking utensils, equipment and fuel to cook and store food safely • Ensuring that people have the knowledge and understanding they need to avoid disease • Containing or removing sources of chemical or radiological contamination, or evacuating people, to ensure they are no longer exposed to these hazards.

Rescue operation In addition, environmental health workers are likely to be involved in providing: • Hospitals and medical facilities • Emergency operation centres • Potable water supplies for organized rescue teams • Assessing the risks from hazardous materials and information on the location of hazards • Information about high-occupancy buildings • Emergency water and sanitation for large, isolated and trapped populations • Handling human and animal corpses • Direct assistance with the retrieval, transportation and temporary storage of human bodies.

Shelter and emergency settlements • Advising on structural integrity for repair of house • Discouraging from staying in homes that are definitely unsafe • Informing people about the nearest safe water supply/ measures they can take to ensure the safety of drinking-water (filtering, boiling, disinfecting, storing in closed containers, etc. ). • Instructing them in the safe disposal of waste, including where and where not to defecate, and in the importance of ORS for children with diarrhoea. • Informing people that water supply may be contaminated. (Sewage, debris). • Distributing a stock solution of bleach or water chlorination tablets • Providing blankets and kerosene lanterns for illumination at night. • Advising on the status of sanitation systems, and (Providing temporary alternative sanitation facilities)

Water supply Situations demanding emergency water supply response Short term • Emergencies affecting rural or unserved periurban communities • Emergencies in urban situations where a central water service is available • Emergencies involving population displacement and temporary shelters Long term • Displacement emergencies that result in semi permanent emergency settlements.

Rural emergencies Floods • Repair or replacement of pumps • Repair of spring catchments • Repair of gravity supply pipes and distribution systems; and providing steel or plastic tanks to replace broken concrete reservoirs. It is common to find in rural areas that a significant proportion of water supply installations are out of order, owing to long-term problems with maintenance and repair.

Urban emergencies Drought • Even if people do not migrate for food but for water they do ! • Diseases like trachoma and scabies, increase during droughts. • The incidence of diarrhoea and waterborne diseases such as cholera also increase (Intensive use of a small number of water supplies vulnerable to contamination) • Drought itself constitute an emergency, even if reserves of cash, food and livestock are sufficient to avoid food shortages. • Water quantity is an absolute priority and health staff should cooperate with the government public works or water-supply departments, and with NGO • During droughts, there is also often a problem of water quality, • Water trucking may be needed following disasters that affect water supplies

Assessment of damage Urban areas • Contamination of the water source • Damage to the water-treatment works, including structural damage, mechanical damage, loss of power supply and contamination due to flooding • Damage to pumping stations • Pressure failure in all or part of a water distribution network, allowing backflow • Badly repaired plumbing in domestic or public buildings, resulting in back siphonage • Failure to disinfect a contaminated source correctly, or to maintain adequate chlorine residual throughout the system.

Safe water needs • For the general population 15 -20 litres per day person • For operating water-borne sewerage systems 20 -40 litres per day person • In mass feeding centres 20 -30 litres per day person • In field hospitals and first-aid stations 40 -60 litres per day person • For livestock accompanying displaced persons and refugees 30 litres per day per cow or camel 15 litres per day per goat or other small animal.

Sanitation Human waste: Faeces • Viruses, bacteria and eggs or larvae of parasites. • Diarrhoea, cholera and typhoid are spread and are major causes of sickness and death in disasters. • Intestinal worm infections are transmitted through faeces and spread rapidly where open defecation occurs and people are barefoot. • Contribute to anemia and malnutrition, and also render people more susceptible to other diseases. • Children are especially vulnerable to all the above infections. • Specific measures should be taken to prevent the spread of infection (e. g. chlorinating water supply, providing hand-washing facilities) The first priority is to isolate and contain faeces.

Mass feeding centers Facilities needed at mass feeding centers • Water supplies • Toilets for staff and users • Hand-washing facilities • Facilities for dealing with liquid wastes from kitchens • Facilities for dealing with solid wastes from kitchens • Adequate and appropriate materials for cooking/refrigeration • Adequate and appropriate materials for eating • Control of rodents and other pests

Vectors and diseases likely to be present in emergency settlements Vector Main diseases Mosquitoes Malaria, yellow fever, dengue, viral encephalitis, Filariasis Houseflies Diarrhoea, dysentery, conjunctivitis, typhoid fever, trachoma Cockroaches Diarrhoea, dysentery, salmonellosis, cholera Lice Endemic typhus, pediculosis, relapsing fever, trench fever Bed bugs Severe skin inflammation Ticks Rickettsial fever, relapsing fever, viral encephalitis Rodent (mites) Rickettsial pox, scrub typhus Rodent (fleas) Bubonic plague, endemic typhus Rodents Rat bite fever, leptospirosis, salmonellosis (specially after flood, eg: Surat and Mumbai)

Disease control » Diagnosis and treatment » Vector control » Environmental hygiene » Personal protection Nuisance control » Identification of the causative agent » Environmental hygiene » Personal protection

Environmental management • Control of mosquito breeding Leveling land, filling borrow pits and draining flooded areas, screening of water containers • Human activities, that concern food production, eating, drinking, sleeping, defecation and laundering, can promote the propagation of vectors and pests or affect contacts between humans and vectors. • Defecation fields should always be kept at a distance from cooking areas, because of flies and possible surface rainfall run-off.

Hygiene and personal protection • Information on hygiene and personal protection should be provided to the public. • Personal protection measures Vaccines, drugs (e. g. for prophylaxis) Pesticides (e. g. in impregnated mosquito nets) Promoted by qualified health staff and used under their guidance. • Vulnerable groups Sick and wounded, children, elderly, pregnant women and people who lack immunity (including relief workers), need additional protection.

Control of communicable diseases and prevention of epidemics Preparedness and prevention • • Training health and outreach staff in the identification and M/m Creating local stocks of supplies and equipment for diagnosis, treatment Strengthening health surveillance systems and practicing protocols Raising awareness among the population likely to be affected by a disaster • Acute respiratory infections and diarrhoea major killers in emergency • Hygiene promotion • Provision of adequate quantities of safe water • Sanitation facilities and appropriate shelter are absolutely necessary • Measles outbreaks are a common hazard in emergencies • Early vaccination campaigns should be considered before any cases appear.

Public health surveillance and outbreak control • Important to designate specific health staff for public-health surveillance. • Neighbourhood and community health workers • Even under the worst conditions of large-scale population movement • Existing reporting systems can be extended to cover priority diseases (serious water- and sanitation-related epidemic diseases) • Typhoid or paratyphoid fever, cholera, typhus, plague, encephalitis or meningitis, as well as to excessive numbers of poisonings (including food poisoning) or cases of malaria. (Histories/Contact identification/source of disease)

Flexibility to rescue team • Coordination of emergency response activities. • Basic facilities for emergency personnel • Security and safety needs of personnel. • Psychological needs of personnel • Transportation and logistics • Some special consideration § When to declare an emergency ? § When to seek for support from outside ? § When to seek for International assistance ? § Zone of disaster and who should move out and who should move in ? § Administrative obligations

Special incidents: Chemical and Radiation emergencies Chemical incidents affect people in a number of ways: • Effects of explosion • Effects of fire • Toxic effects of the chemicals Common measures to reduce the health risks of chemical incidents: • Registering all chemicals in commercial establishments • Clearly labelling all chemicals in transit • Rapidly notifying the chemical incident emergency • Decontaminating land or water already contaminated by waste disposal.

Mortuary services and handling of the dead • Dead/decayed human bodies do not generally create a serious health hazard • Unless they are polluting sources of drinking-water with faecal matter • Or infected with plague or typhus • Families may carry out all the necessary activities following a death • Special issues which should be given notice are: » » Recovery of the dead Organization of the mortuary Identification of the dead Handling the dead Disposal of animal dead body/ Caracas specially in flood situation

Health promotion and community participation Public awareness raising /mobilization programmes play an essential part in reducing disaster vulnerability by: • Increasing public awareness of environmental health hazards • Informing people how disasters can be prevented/ impact can be reduced • Increasing people’s awareness of the threats to health • Encouraging people to participate in protecting : § Themselves § Environment § Health services From disaster and the effects of disaster.

Communications activities • Education in schools for children and adolescents • Special education programmes for adults § Specifically on disaster preparedness § As an integral part of ongoing health or development programmes • Public information through the mass media • Information and mobilization through local organizations

Current initiatives (Indian perspective) • The India Disaster Resource Network (IDRN) initiated by the Ministry of Home affairs in collaboration with the UNDP. • Organised Information system for collection and transmission of specific equipments and expertise database. • Quick decision in mobilising equipments and skilled human resources during emergencies. • Involvement of Panchayati Raj Institutions, Urban Local Bodies and the NGO’s for complete, coordinated effort. § § Culture of Preparedness Culture of Quick Response Culture of Strategic Thinking Culture of Prevention

4 functional groups assigned with specific tasks are: Functional Group 1: Hazard Mitigation Functional Group 2: Preparedness and Capacity Building Functional Group 3: Relief and Response Functional Group 4: Administration and Finance

References 1. Wisner B and Adams J. Environmental health in emergencies and disasters. Geneva. World Health Organization, 2002. Connolly MA. Communicable disease control in emergencies: A field manual. Geneva. World Health Organization, 2005. 3. Waring SC and Brown BJ. The threat of communicable diseases following natural disasters, a Public Health Response. New York. Disaster Manage Response, 2005. 4. World Health Organization and Pan American Health Organization. Management of dead bodies in disaster situations. Washington, D. C. WHO and PAHO, 2004. Further Reading 1. http: //www. ndmindia. nic. in (National Disaster Management, Ministry of Home Affairs, Govt. of India) 6. http: //www. southasiadisasters. net (All India Disaster Mitigation Institute, Ahmedabad, Gujarat) 7. www. indiadisasters. org