4/22/20151 EMERGENCY HEALTH PROBLEMS AFTER DISASTERS 3.3 OFDA photo

4/22/20152 InterWorks/UNHCR Major Reported Causes of Death Children <5 Years, Refugee-Hosting Areas 9 Districts, July % 11% 10% 22% 23%9% Source: UNHCR, MSF, ARC, IRC monthly report (< 5 years of age deaths) Malnutrition ARI/Pneumonia Malaria Diarrhea Measles Other PROBLEM 1: Disaster displaced populations, especially children, are particularly susceptible to five killer diseases

4/22/20153 Cause of Death of those age >4 IRC Kelamie 2000

4/22/20154 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.

4/22/20155 BUT NOT ALWAYS - CONSIDER THESE CASES... NO excess mortality from communicable diseases nn Earthquakes in Turkey nn Floods in Mozambique nn Earthquake in El Salvador nn Hurricane Mitch nn World Trade CenterWorld Trade Center Attack nn Papua New Guinea tsunami

4/22/20156 Cause of Death all ages Sarajevo, Bosnia MSF Physical Trauma e.g. violence Cardiovascular 10% Other 16% Pneumonia 3% Cancer 3%

7 Problem 2: Managers and health specialists do not adequately understand the overall health situation of large, moving or displaced populations. UNHCR photo 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.

4/22/20158 Problem 3: Other key sectors are not adequately addressed, resulting in serious public health threats,ultimately requiring curative health response UNHCR photo/R. Darolle: Kao I Dang refugee camp, 1983

4/22/20159 Problem 4: Diarrheas have traditionally become deadly in mass displacement scenarios. Is this still true today? UNHCR photo, H.J. Davies, - Cholera and other water-borne diseases claimed up to 3,000 live a day in late July 1994, Goma, Zaire Haiti, 2010 post-earthquake epidemic

4/22/ 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.

4/22/ MCH clinic reporting, Children Kabul Afghanistan 1997

4/22/ Dysentery: 3 or more liquid stools per day with blood

4/22/ Faryab Province, Afghanistan 2001 Famine and IDP by Save US CMR of 2.6/10,000/day reported

4/22/ Faryab Province, Afghanistan 2001 Famine and IDP by Save US CMR of 2.6/10,000/day reported Malnutrition

4/22/ 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. 1 out of 10 cases may die. MSF photo

4/22/ IV drip treatment of cholera victims at a refugee camp in Mozambique. [Medecins Sans Frontiers/Doctors Without Borders photo]

4/22/ 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

4/22/ 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

4/22/ Problem 7: Overcrowding and lack of vaccination coverage result in life- threatening epidemic outbreaks of otherwise easily controlled diseases Jalozai refugee camp, Aug. 2001

4/22/ 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,

4/22/ “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

4/22/ 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

4/22/ PROBLEM 10: Inappropriate or inadequate health programs result in higher than necessary rates of morbidity and mortality

4/22/ people have died in a population of 20,000 in the last three months. What is the death rate, and what does it mean? 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? 60 (deaths) x 10, (days) x 20,000 (total pop.) 53 (deaths) x 10, (days) x (total pop. under 5) = 0.33 OK

4/22/ This is the age profile of the population TOTAL POPULATION IS 20, % < 5 = 2,600 people +12% 5 - < 15 = 2,400 people +15% 15 - < 20 = 3,000 people +52% 20- < 60 =10,400 people + 8% 60 + = 1,600 people = 100% =20,000 people How do you determine the <5 MR?

4/22/ (deaths of children<5) x 10, (days) x (2,600 children<5) Now review the chart or CMRs around the world on page 311 of the 2011 Sphere handbook. What does the chart tell you? 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? = 2.3

4/22/ 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.