1. Just-in-Time Lecture Pakistan Earthquake 8 October 2005
Just-in-Time Lecture
Pakistan Earthquake
8 October 2005
This lecture is dedicated by Global Health Disaster Network (GHDN) to the victims of Pakistan earthquake, 8 Oct 2005.
Please send the messages to and It would be great to have you involved.
Authors:
Ali Ardalan, MD, MPH, Ph.D.
Assistant Professor
Health in Emergency & Disaster Division
Institute of Public Health Research
School of Public Health & Institute of Public Health Research
Tehran University of Medical Sciences
Tehran, Iran
Khawar Kazmi MD
Associate Professor & Consultant Cardiologist
Department of Medicine
Director of Smart Heart Program
Aga khan University
Karachi, Pakistan
Ronald E. LaPorte, Ph.D. Professor of Epidemiology
Director, Disease Monitoring and Telecommunications, WHO Collaborating Centre Graduate School of Public Health University of Pittsburgh USA
Kourosh Holakouie Naieni MPH, Ph.D.
Professor
Sunita Dodani MD, FCPS, MS
Department of Epidemiology
University of Pittsburgh
Pittsburgh, PA USA
Farshad Pourmalek MD, MPH, PhD
Eugene Shubnikov, MD
Senior Research Fellow
Institute of Internal Medicine
Novosibirsk City, Russia
Faina Linkov, M.P.H.
Research Assistant
Mehdi Russel MD, MBA, Ph.D.
General Secretariat of Health Risk Management & Emergencies
Ministry of Health & Medical Education
Iran
Eric K Noji, MD, MPH
Senior Advisor to the Director
Office of Emergency Preparedness & Response (NCEH/ATSDR)
Centers for Disease Control (CDC)
USA
Ardalan A, Kazmi Kh, LaPorte RE, Holakouie Naieni K, Dodani S, Pourmalek F, Shubnikov E, Linkov F, Russel M, & Noji EK

2. Mission Statement:
The Global Health Network Disaster, Network for Earthquake is designed to translate the best possible scholarly information from leading researchers to educators worldwide.

3. What is the Disaster Supercourse?
The Supercourse: A global network of 18,000 academic faculty from 151countries (
More than 2000 cutting edge lectures from leading scientists including 6 noble prize winner.
The mission is to provide for free the best possible education materials on health, here it is applied to earthquake disaster.
For more information, please view the following lectures:
Introduction to the Supercourse. By Ronald LaPorte
Supercourse overview. By the Supercourse team
Turning the Alley of Information Exchange in Developing Countries to the Super Highway. By: Ali Ardalan

4. What is a JIT lecture? http://www.pitt.edu/~super1
A JIT lecture is one of the special applications of the Supercourse blossoms when a major event happens around the world. These Cutting Edge Educational lectures aim to reduce fear and save lives by providing the best possible knowledge. In the field of disasters, continuous “CNN Type” PowerPoint lectures are provided on the science aspect of disasters and the epidemiology of their consequences.
Following Hurricane Katrina & Hurricane Rita, 2005, on behalf of the Global Health Network (GHN) for Disasters, Ali Ardalan, Ronald E. LaPorte, Kourosh Holakouie Naieni, Eugene Shubnikov, Faina Linkov, Mehdi Russel & Eric K. Noji developed 2 JIT lectures. The Hurricane lecture are translated to Chinese and Spanish and visited by thousands people around the world. This lecture disseminated through the Texas high schools before Katrian hit there.
Following the South Asian Tsunami, 26 Dec 2004, on behalf of the Global Health Network (GHN) for Disasters, Ali Ardalan, Ronald E. LaPorte, Eugene Shubnikov, Faina Linkov & Eric K. Noji developed two JIT lectures, which the crude estimate showed that in a 5 day period from January 5th to January 9th, over 255,000 people worldwide learned from those lectures.
When the earthquake in Bam, Iran 26 Dec 2003 occurred, Ali Ardalan from Iran worked with Eric Noji and Ronald LaPorte from the US, and Eugene Shubnikov from Russia. Dr. Ardalan developed a JIT lecture within few days ( and updated it ( That was a memorable collaboration, among Russia, Iran and the USA. This was published in the Lancet, and demonstrated how Global Disaster Training could be accomplished. The lecture was used world wide by thousands of educators and seen by a multitude of students.
The JIT lecture by Rashid Chotani from Johns Hopkins demonstrated JIT lectures and emerging diseases. He worked with the Supercourse group, and updated the lecture every 2 days ( This article was also published in the Lancet.
We have honed our teachings with other JIT lectures including “Mad cow disease” and “Monkey pox”.
The model of JIT lectures develops a first lecture describing the scientific basis of the disaster, which can be modified for any country in the world, and then a second CNN type lecture that is on distributed through , and the web, updating the lecture on a regular basis and distributed worldwide on the web.

5. To provide the best possible scientific information about the Pakistan
Lecture objectives:
To provide the best possible scientific
information about the Pakistan
earthquake of 8 Oct 2005
To teach how the science can help
prepare for primary & secondary
prevention of consequences of
Pakistan earthquake, 8 Oct 2005

6. What is the earthquake?
The shaking of earth caused by waves moving on and below the earth's surface and causing: surface faulting, tremors vibration, liquefaction, landslides, aftershocks and/or tsunamis
Earthquake is a term used to describe both sudden slip on a fault, and the resulting ground shaking and radiated seismic energy caused by the slip, or by volcanic or magmatic activity, or other sudden stress changes in the earth.
Useful links:

7. How the earthquake happens?
It caused by a sudden slip on a FAULT.
Stresses in the earth's
outer layer push sides of
fault together.
Stress builds up & rocks
slips suddenly, releasing
energy in waves that travel
through the earth's CRUST
& cause the shaking that we
Feel during an earthquake.
What is a fault that we talk about it in the earthquake?
A fault is a fracture along which the blocks of outermost major layer of the earth, on either side have moved relative to one another parallel to the fracture. Faults are classified to Strike-slip and Dip-slip faults (normal, reverse and thrust).
What is the crust?
The outermost major layer of the earth is called CRUST and ranging from about 10 to 65 km in thickness worldwide. The uppermost km of crust is brittle enough to produce earthquakes.
To learn more about the types of faults, please look at:

8. Earthquake Strength Measures I) Magnitude & II) Intensity
Definition: A measure of actual physical energy release at its source as estimated from instrumental observations.
Scale: Richter Scale
By Charles Richter, 1936
Open-ended scale
The oldest & most widely used
There are 2 measures to identify the strength of an earthquake: 1) Magnitude & 2) Intensity. In this and the next slides you can learn what the definitions and the scales of the aforementioned measures are.
Useful links:
Public Health Consequences of Earthquakes.
Part I.
Part II.
Noji 1997

9. Earthquake Strength Measures I) Magnitude & II) Intensity
Definition: a measure of the felt or perceived effects of an earthquake rather than the strength of the earthquake itself.
Scale: Modified Mercalli (MM) scale
12-point scale, ranges from barely perceptible earthquakes at MM I to near total destruction at MM XII
Intensity is a measure of how severe the shaking was at a particular location and is determined by classifying the degree of shaking severity as measured by an intensity scale.
Modified Mercalli (MM) Scale Categories:
I. Felt only by a very few people under especially favorable circumstances
II. Felt only by a few people at rest, especially on the upper floors of buildings. Suspended objects may swing.
III. Felt quite noticeably indoors. Standing motor vehicles may rock slightly. Vibration like the passing of a truck.
IV. Felt indoors by many, outdoors by a few. At night, some awakened. Crockery, glassware, windows, doors rattle.
V. Felt by nearly everyone; damage to contents and structures uncommon but possible.
VI. Felt by all; many frightened and run outdoors; damage slight.
VII. Everybody runs outdoors; damage negligible to buildings seismically well-designed and constructed; slight to moderate to ordinary structures; considerable damage to poorly built or badly designed structures.
VIII. Damage slight in well-designed, considerable in ordinary, and great in poorly built structures; chimneys, monuments, walls, etc., fall.
IX. Damage considerable to well-designed structures, and great (including partial or complete collapse) in other buildings; buildings shifted off foundations; underground pipelines disrupted.
X. Some well-built wooden structures destroyed; most masonry and ordinary structures destroyed; railroad tracks bent; landslides common; water spills over banks of streams, lakes, etc.
XI. Few, if any, masonry structures remain standing; bridges are destroyed; broad fissures open in the ground; underground pipelines are completely out of service; earth subsides.
XII. Damage is total; waves are seen propagating along surface of the ground; nearly impossible to stand; objects thrown up into the air.

10. Magnitude versus Intensity
Magnitude refers to the force of the earthquake as
a whole, while intensity refers to the effects of an
earthquake at a particular site.
An earthquake can have just one magnitude, while
intensity is usually strongest close to the epicenter
& is weaker the farther a site is from the epicenter.
The intensity of an earthquake is more germane to
its public health consequences than its magnitude.
“The intensity is assigned for a particular location on the basis of the visible consequences left by the earthquake and from subjective reports by people who experience the shaking.
Intensity scales also allow comparisons with earthquakes that occurred before the development of seismic monitoring instruments. The destruction that an earthquake causes is a function of its intensity and the resistance of structures to seismic damage. “

11. + Northward movement of the Indian subcontinent
(40 mm/yr = 1.6 inches/yr) +
Colliding with the Eurasian continent
The Himalayan, the Karakoram, the Pamir and the Hindu Kush ranges are the result uplift by this collision.
Near the town of Muzaffarabad (10 km SE of the earthquake epicenter), active thrust faults that strike NW-SE have deformed and warped Pleistocene alluvial-fan surfaces into anticlinal ridges.
Earthquakes & active faults in
Northern Pakistan
& adjacent parts of India & Afghanistan
USGS

12. Seismicity of Pakistan Concentrated in N and W of the country, along
the boundary of the Indian plate & the Iranian
& Afghan micro-plates
Thrust zones:
Kirthar
Sulaiman
Salt ranges
4 faults in & around Karachi
The Chaman Fault runs along Pakistan's western frontier with Afghanistan from Kalat, in the northern Makran range, past Quetta and then on to Kabul, Afghanistan. A fault also runs along the Makran coast and is believed to be of the same nature as the West Coast fault along the coast of Maharashtra, India.
An active subduction zone exists off the Makran coast that the great 1945 earthquake was centred in this region (The subduction zone is the place where two lithospheric plates come together, one riding over the other)
Tsunamis or tidal waves have also affected the coast of Pakistan!! The worst case was in 1945 when an earthquake of magnitude 7.9 struck the Makran coast, waves as high as 12 meters were reported.

13. Peak Ground Acceleration (m/s2)
What is the Peak Acceleration? The change from one speed, or velocity, to another is called acceleration. During an earthquake when the ground is shaking, it also experiences acceleration. The Peak Acceleration is the largest acceleration recorded by a particular station during an earthquake.
Peak Ground Acceleration (m/s2)
Based on Expected Ground Acceleration, Pakistan is divided into 4 earthquake hazard zones.

14. Seismicity of Jammu & Kashmir
Earthquake, 8 Oct 2005:
One of the strongest earthquakes in the area since a mammoth M7.6 in Sep 1555 with max density XII in Kashmir (Jammu & Kashmir) and India
The earthquake 8 Oct was felt in Islamabad and Lahore, and India's capital of New Delhi.
Useful links:

15. History of earthquakes in Pakistan, 1980-2004 Death M Main Location
Date 23
6.3
Gilgit-Astore
20 Nov 2002 17
5.3
3 Nov 2002 1
5.5
1 Nov 2002 20
7.6
Near Bhachau (Gujarat)
26 Jan 2001 50
7.3
Near Harnai (Baluchistan)
27 Feb 1997 -
7.0
Hindukush Mountains
9 Aug 1993
300
6.7
31 Jan 1991 5
7.4
29 July 1985 14
30 Dec 1983
6.1
Gilgit Wazarat
(Jammu & Kashmir), India
12 Sep 1981
Source:

16. Largest earthquake in Pakistan ! Date: 30 May 1935
Location: Quetta / Balouchistan
Magnitude: 8.1 on the Richter scale
Time: 19:00:46.9 UTC
Epicentre: 27.39N, 88.75E
Depth: 17 Kms
Death: 30,000
The most vulnerable parts of Pakistan are parts of Balochstan province in and around Quetta stretching to the Afghan border and western parts of Balochistan, which include the Makran coast till the Iranian border. These regions could expect to have a maximum peak ground acceleration (PGA) ranging between 0.24g to 0.4g.

17. Pakistan’s Health Statistics: Total population: 153,578,000
GDP per capita (Intl $, 2002): 1,920
Life expectancy at birth m/f (years):
62,0/62,0
Healthy life expectancy at birth m/f
(years, 2002): 54,2/52,3
For Pakistan’s Health statistics, please see:

18. Pakistan’s Health Statistics: Child mortality m/f (per 1000): 98/108
Adult mortality m/f (per 1000): 225/199
Total health expenditure per capita
(Intl $, 2002): 62
Total health expenditure as % of GDP
(2002): 3,2
For Pakistan’s Health statistics, please see:

19. Pakistan Earthquake, 8 Oct 2005: Geolocation: 34.402°N, 73.560°E
Region: Pakistani controlled Jammu &
Kashmir at N of Pakistan & Punjab
& Himachal Pradesh at N of India.
Countries affected: Pakistan, India,
Afghanistan
Affected area: Forest-clad mountains
After J&K the other most affected area is in North West Frontier province. The areas are Balakot, Abbottabad and Kaghan Valley.

20. Pakistan Earthquake, 8 Oct 2005: Depth: 10 km (6.2 miles)
Epicentre Distances from Islamabad: 90 Km NNE
Epicentre Distances:
90 km NNE of ISLAMABAD, Pakistan
15 km ESE of Mingaora, Pakistan
120 km WNW of Srinagar, Kashmir
165 km N of Jhelum, Pakistan
USGS: Near the town of Muzaffarabad, about 10 km southwest of the earthquake epicenter, active thrust faults that strike northwest-southeast have deformed and warped Pleistocene alluvial-fan surfaces into anticlinal ridges. The strike and dip direction of these thrust faults is compatible with the style of faulting indicated by the focal mechanism from the nearby M 7.6 earthquake.
Muzaffarabad is the capital of Pakistan-controlled Kashmir.

21. Pakistan Earthquake, 8 Oct 2005:
Magnitude: 7.6 on the Richter scale (USGS)
7.8 on the Richter scale (JMA)
Classification: Major
Aftershock: ~ 200 from 5.4 – 6.2
Date: Saturday 8 Oct 2005
Time: 8:50 AM at the local time
USGS: United States Geographical Survey
JMA: Japan Metrological Agency

22. Pakistan Earthquake Impacts
Death toll: ~ 50,000
Injured: ~ 70,000
Affected population:
Severely:
Marginally:
Displaced/homeless:
3.3 million
It is supposed that the death toll climbs significantly as more areas become accessible and more bodies are pulled out of rubble.
Thousands of injured need to surgery to repair broken or crushed limbs, head, spinal & chest trauma
Nearly half of the four million affected people are in Pakistan-controlled Kashmir and another 1.3 million in North West Frontier Province.

23. Balakot area: The worst hit area 20,000 causalities 90% buildings
destruction
100% homeless
Muzaffarabad:
80% destroyed
City of Bagh:
Totally destroyed
Main affected areas
In Pakistan administered regions of the epicentral tract, a majority of the deaths occurred in the town of Muzaffarabad where an estimated 80% of the buildings collapsed.
The nearby town of Balakot was completely destroyed along with several mountain villages.
The towns of Bagh and Rawalakot close to the Line of Control (LoC) also suffered extensive damage.
Major landslides and rock falls buried some mountain villages and wiped out roads in the region. Near Muzaffarabad, a large landslide in the Neelam valley dammed the river of the same name. Landslides also temporarily blocked the Srinagar-Muzaffarabad Highway while the Aman Setu on the LoC suffered some damage. Landslides were also reported in the Hazara region including at Astore, Gilgit and Skardu where the earthquake was felt. 

24. Damage to health infrastructure: Destruction of: 26 hospitals
3 Tuberculosis hospitals
> 600 PHC centres
At least 26 hospitals and 600 health clinics have been destroyed or severely damaged.
Health workers have been killed, injured, or traumatized.

25. When disaster strikes, years of development can be wiped out in seconds
The United Nations flash appeal for Pakistan to cover the relief needs for a 6 months emergency phase:
US$ 312 million
Over 80 percent of the structures have been destroyed in the affected areas.
The Government of Pakistan estimates the cost to rebuild the quake-affected areas to cost US$ 5 billion.
UN estimates the cost of rebuilding the affected areas could run into the billions of dollars over a 5-10 year period.

26. Relief operation obstacles: Huge numbers of injured
Helicopters as the only means to get to cut-off
villages
Logistical challenges
Rapidly deteriorating weather conditions
Continuous rains at nights
Blocking roads by landslides
Heavy clouds
Relief teams faces with some obstacles the slow down their operation. You see a list of those problems in this slide. In this regard the 2 below points are considerable:
Death of 6 Pakistani soldiers in a helicopter crash due to bad weather!!
Not accessible area: 50% of the entire affected area!!
Number of mountainous villages in the affected area: 2,000 (UN OCHA) to over 15,000 (WFP) spread over some 30,000 square miles (DFID).

27. Critical needs of the affected population:
Winterised shelter up to 600,000 (based on
3 million needing shelter, 5 persons per
family)
Medical services
Water & sanitation
Nutrition
Reaching populations in villages
In this slide you see the critical needs of the earthquake-stricken people. The huge number of the affected population, geographical extension of damages and hard accessibility to the affected areas have result in difficult and slow basic and health service delivery.

28. Health needs & concerns: Cold temperature (<0) & hypothermia
Lack of sanitation facilities
Lack of adequate & safe drinking water
Need to water purification plants & Water tanks
Need to latrines
Problem of sanitary disposal of excreta and
Basic hygiene
Inadequate food
Unaccompanied, separated, orphaned children
Risk of diarrhoeal illnesses, pulmonary diseases
& non-treatment of injured and infected open
fractures & gangrenes
WHO: South Asia Earthquake, SitRep 9,16 Oct :
The aftermath of the earthquake, the devastation and the impact on people’s lives has been underestimated.

29. Dead bodies do not lead to epidemics,
but the bad odour is always a problem, as
it is true in Pakistan and was in Bam.
Solution: Spraying campaigns with chlorine
As a myth in disasters people believe that the Dead bodies lead to epidemics, while as the reality it does not happen. However, the bad odour is always a problem, as it is true in Pakistan and was in Bam.
Please look at this article: Dead bodies do not pose health risk in natural disasters. Available:

30. Increasing number of people moving into
A major problem in efficient service delivery to really affected people:
Increasing number of people moving into
Balakot from outlying villages seeking
assistance!
Please see:

31. Bam earthquake lessons learned: We should focus on:
Incident Command System (ICS)
Inter and Intra sectoral Coordination
Emergency Health Information System
(EHIS)
Regarding the lessons learned from Bam earthquake, the health sector management should emphasize on the following points:
Incident Command System (ICS), Inter and Intra sectoral Coordination and Emergency Health Information System (EHIS). These lessons can be applied in the current situation of Pakistan earthquake.

32. Public Health Consequences of Earthquakes
Pease see the following lectures:
Part I.
Part II.
Earthquakes affect the health of people in different aspects: mental health, reproductive, communicable disease, nutrition and food security, water and sanitation and etc.
To know how to deal with public health concerns following the emergencies, please look at:
For more information about the Public Health Consequences of Earthquakes, please see the following lectures:
Part I.
Part II.
Useful links:
The following links provide useful materials about the experiences of Bam earthquake, Iran and Bhju, India:
Disaster Epidemiology Lessons From Bam Earthquake Dec 26, 2003 Iran. Part`1- 7
The Iranian Earthquake. BAM, December 26, 2003
Experience in the aftermath of the earthquake at Bhuj in India
Text book:
The Public Health Consequences of Disasters, edited by Eric K Noji. Chapter 8. New York, Oxford University Press 1997.

33. Time of Pakistan earthquake,8 Oct 2005:
Around 9 AM on Saturday & most students were at schools when the earthquake struck !!
From the news it appears that in Muzaffarabad, Bagh and Balakot no school building is standing and this includes junior and senior schools and at 9 am on the fateful day the classrooms were full .In these areas students walk many miles on foot through rough terrains to reach their schools.

34. Epidemiology of fear: Dr. Khawar Kazmi
I feel we need to reach out first, are schools all over Pakistan but particularly in cities like Lahore and Islamabad who experienced earthquake but fortunately escaped with out major damage. These young minds are also affected by the stories of hundreds of young students who have lost their lives in other areas. 
In many areas of the world, like Pakistan and Iran, earthquake is the feature of our life. The death risk following earthquake in the developing countries in not usually more than other accident related death. Just we need is understanding the nature and characteristics of the earthquake. We should learn how be prepared and what we should do when it happens.
Dr. Khawar Kazmi

35. People need information as much as water, food, medicine or shelter.
Information can save lives, livelihoods &
resources.
Lack of information can make people
victims of disaster.
World Disaster Report 2005 – IFRC/RCS

36. Just-in-Time Education: Let’s teach the school children right now !
Are the schools of your community are prepared & earthquake resistant?
Maybe it is more efficient to start the education from the schools, as our students build the next generation of the country. They can live safely and transfer the knowledge to their children. In not long term, we will find the earthquake as just “Dance of Earth” that we will move with it and enjoy!
Just-in-Time education saves the time and cost of the public education, as the people are looking for learning !
Please use of the following links to learn the school children about Earthquake Preparedness:

37. Average Disaster Per Year in Pakistan
This slide shows that the floods occurs 1.54 times more than the earthquakes in Pakistan.
UNDP

38. Proportion of People Killed per Type of Disaster (1980-2000)%
As you see in this slide, the death risk of flood in Pakistan has been about 6.5 more than earthquake death risk during
UNDP

39. Comparison of Proportion of People Killed following Earthquakes between Pakistan & other countries ( ) %
As you see in this slide, the earthquake death risk in Pakistan has been 25% less than Iran and 11% less than Japan during
UNDP

40. 30 times more death due to CVDs than earthquakes
Comparison of 10-year death in Pakistan between Cardiovascular Diseases (CVD) & Earthquakes
30 times more death due to CVDs than earthquakes
Rough estimates shows that about 150,000 people , in average, died annually because of the cardiovascular disease (CVD) in Pakistan.
Comparison of the 10 year death due to CVD and earthquake reveals about 30 times more death because of CVD in Pakistan!!

41. Almost unpredictable disaster No early warning
Earthquake Nature:
Almost unpredictable disaster
No early warning
No scientific prediction technology
But we can protect ourselves & minimize the damage to our homes, schools & work places.
Please see the next slide to learn how we can minimize our vulnerability to earthquakes!

42. What we should do/do not before, during & after the earthquake?
Please read carefully at:
Useful links:

43. References

44. We wish to express our warm thanks to GDHNet faculties and all groups that contributed their valuable materials.
The Supercourse Team invites you to see the web-casted Cutler Lecture on Sept. 29 at the Graduate School of Public Health at the University of Pittsburgh presented by Dr. Eric Noji on Global Disasters.
Available: