1. WASH Cluster – Emergency Training D D2 1 WASH Related Diseases Session 2 Public Health Impact of Selected Disasters

2. WASH Cluster – Emergency Training D D2 2 Session Aim To understand the types of disasters and the types of public health impact associated with each type of disaster

3. WASH Cluster – Emergency Training D D2 3 Session Objectives – Describe one way in which disasters are categorised Explain the risk of WASH related diseases in different types of emergencies List the four major infectious diseases Session Name here3

4. WASH Cluster – Emergency Training D D2 4 Are epidemics of communicable diseases inevitable after every type of disaster? Question to group

5. WASH Cluster – Emergency Training D D2 5 Myth “Myth Number 3: Epidemics and plagues are inevitable after every disaster. Reality: Epidemics do not spontaneously occur after a disaster, and dead bodies will not lead to catastrophic outbreaks of exotic diseases. The key to preventing disease is to improve sanitary conditions and educate the public” Source: Noji and Toole, 1997

6. WASH Cluster – Emergency Training D D2 6 Environmental/WASH related diseases Question to group? What is the risk of WASH related diseases in different types of emergencies?

7. WASH Cluster – Emergency Training D D2 7 Public Health Impact of Selected Disasters EffectComplex emergencies EarthquakesHigh Winds (without flooding) FloodsFlash floods or tsunamis DeathsMany Few Many Severe injuries. VariesManyModerateFew Increased risk of comm. diseases HighSmall VariesSmall Food ScarcityCommonRare VariesCommon Major population displacements CommonRare CommonVaries Source: 1 st Draft, Health Chapter, Sphere, March 2010

8. WASH Cluster – Emergency Training D D2 8 Public Health Impact of Selected Disasters “Increased rates of morbidity and mortality due to communicable diseases occur more frequently in association with complex disasters than other disasters. In many of these settings, especially those occurring in developing countries, between 60% and 90% of deaths have been attributed to one of four major infectious causes:

9. WASH Cluster – Emergency Training D D2 9 Public Health Impact of Selected Disasters “CDC studies clearly documented evidence that mortality rates among refugee populations were sometimes 10 to 20 times higher than death rates in their countries of origin” Source: Noji and Toole, 1997

10. WASH Cluster – Emergency Training D D2 10 Public Health Impact of Selected Disasters A recent review of over 600 geophysical disasters since 1985 found only three instances where such disasters led to epidemics (Floret et al., 2006, p. 543). This is hardly surprising as such disasters often lack the aggregation of populations which Topley’s work (1988) suggests is a factor in the biology of epidemics. Toole (1997, p. 79) makes the same point, that outbreaks of communicable disease are rare after natural disasters unless large numbers are displaced from their homes and placed in camps. The problem with basing actions on myths is that resources that could be better used for dealing with real problems are frittered away on imaginary ones. Even though there was no confirmed case of cholera in Aceh, an immunisation campaign targeted 160,000 people with preparations for cholera (Guha-Sapir and Panhuis, 2005, p. 19) using an expensive two dose oral vaccine. Source: ALNAP Lessons Earthquakes 2008

11. WASH Cluster – Emergency Training D D2 11 Public Health Impact of Selected Disasters Disaster response should be based on needs assessment and not on myths. As a review of health action after the 2004 tsunami noted: ‘There is no substitute[e], even in emergencies,for evidence based response’ (Guha-Sapir and Panhuis, 2005, p. 19). Source: ALNAP Lessons Earthquakes 2008

12. WASH Cluster – Emergency Training D D2 12 Public Health Impact of Selected Disasters “More than 80% of current complex emergencies occur in malaria endemic areas” Source: Malaria control in complex emergencies, WHO 2005

13. WASH Cluster – Emergency Training D D2 13 Public Health Impact of Selected Disasters Question to group What are the four major infectious diseases associated with complex emergencies?

14. WASH Cluster – Emergency Training D D2 14 Communicable Diseases Measles Diarrhoea Acute Respiratory Infections and Malaria Source: The Sphere Project, Health Chapter, 1 st Draft, March 2010

15. WASH Cluster – Emergency Training D D2 15 Reported Deaths and Bodies Collected Goma Area, Zaire, July 1994 Deaths Bodies % Dying ReportedCollectedOutside Facilities 18/7-24/71,971 8,661 77.2 25/7-31/71,70729,513 94.2 1/8-7/8 652 7,361 91.2 Total4,33045,535 90.5 * Source: UNHCR/CDC Reports via Peter Salama, UNICEF, New York

16. WASH Cluster – Emergency Training D D2 16 Communicable Diseases “Acute malnutrition is often associated with increased case fatality rates of these diseases, especially among young children…….. …..Outbreaks of communicable diseases are far less commonly associated with acute onset natural disasters. When they do occur, they are generally associated with disruptions of sanitation and poor water quality” Source: The Sphere Project, Health Chapter, 1 st Draft March 2010