1. Disaster Epidemiology in the Republic of Macedonia Prof. D-r Elisaveta Stikova MD, PhD Medical Faculty, National Public Health Institute

2. Disaster Epidemiology in the Republic of Macedonia Learning objectives  To explain the theory of disaster occurrence  To present the most relevant characteristics of disasters in the country by: Affected population (victims), Economic damage lost, Frequency of occurrence (trend)  To evaluate epidemiological characteristics using common indicators (annual average incidence of disasters and disaster ranking),  To explain how these indicators could be used for risk assessment and comparison among the countries from the region

3. Disaster Epidemiology in the Republic of Macedonia Elisaveta Stikova Present position  1991-Present, Professor, University “Ss. Cyril and Methodius”, Medical faculty, Skopje, Macedonia (courses taught: Occupational Health, Public Health, Medical Ecology, Hygiene  1994 – Present, Director and Advisor, National Public Health Institute, Skopje, Macedonia  2009 – Fulbright Visiting Scholar, Pittsburg University, Graduate School of Public Health – New Educational Pathway for Global Public Heath Security

4. VULNERABILITY DISASTER THREATS Age and gender Poverty Infrastructures Food security Health Care Education Environment Emergency response Epidemics Natural Disasters Technological disaster CHBR terrorism Humanitarian crises CAPACITY BUILDING DEVELOPMENT PLANNING Preparedness Planning Policies, Laws and By-laws Awareness & Partnership Operational Systems Human Recourses Early Warning Systems Contingency planning

5. Occurence Damages* Legend: Geophysical Meteorological Climatological Hydrological Victims Natural Disasters by Groups and Impact, 2007

6. Macedonia 48,8 % China Rep. 120 117 437 India 38 145 269 Lesotho 19,4% Zimbabwe 18% Bangladesh 14,4% Zambia 12,8% Dominica 10,5% China Rep 9,1% Bolivia 8,4% Belize 6,4% Bangladesh 22 935 841 Zimbabwe 2 117 207 Philippines 2 023 221 Mexico 1 858 058 Pakistan 1 653 622 Veit Nam 1 647 928 Columbia 1 613 736 Zambia 1 553 536 Swaziland 35,4% Geophysical Climatological Hydrological Meteorologic 120100806040201020304050 10 top countries by victims/ 1000000 in 2007 Legend:

7. Disasters in Europe by Victims/100000 Inhabitant

8. EM-DAT: The OFDA/CRED International Disaster Database – www.emdat.be

9. Disaster Profile of the Republic of Macedonia EM-DAT: The OFDA/CRED International Disaster Database – www.emdat.be

10. Disaster Profile of the Republic of Macedonia

11. Epidemics in the Region 2000 -2009 Start EndCountry Locati on TypeSub TypeName Kille d Tot. Affected 00/07/2002 Albania Gjinokastr u Epidemic Unknown 226 29/08/2000 29/0082000 Bosnia- Hercegovenia Tensaj Epidemic Viral Infectious Diseases Acute hepatitis A 400 12/03/2003 20/04/2003 ItalyEpidemic Viral Infectious Diseases Acute respiratory syndrome (SARS) 4 00/06/2002 Italy Campania Epidemic Viral Infectious Diseases 3 9997 30/11/2002 R.Macedonia Kuman ovo EpidemicUnknown200 01/11/2001 06/02/2002 Serbia Montenegr Lypjan, Ferizaj, Prishtin… Epidemic Bacterial Infectious Diseases Tularemia 170 26/03/2003 SpainEpidemic Viral Infectious Diseases Acute respiratory syndrome (SARS) 1 01/07/2001 18/07/2001 Spain Murcia Epidemic Bacterial Infectious Diseases Legionellosis 2 751 Created on: Mar-31-2009. Data version: v12.07

12. Distribution of Different Hazards and Trends – R. Macedonia, 1989-2006

13. Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Number of deathsNumber of events Total deathsTotal events 250 200 150 100 50 0 8765432187654321 Hazard Incidence and Number of Deaths, Each Hazard- R. Macedonia, 1989-2006

14. Hazard Incidence and Total Number of Victims, Each Hazard - R. Macedonia, 1989-2006 Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Number of victims Number of events Total victimsTotal events 120000 100000 80000 60000 40000 20000 0 8765432187654321

15. Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Economic loss (million USD) Number of events Total economic lossTotal events 400 350 300 250 200 150 100 50 0 8765432187654321 Hazard Incidence and Economic Lost due to All Hazard - R. Macedonia, 1989-2006

16. Total economic damages reported (2003 US$ million) Total number of hazards (natural and technology) 1 9 8 9 - 1 9 9 3 1 9 9 4 - 1 9 9 8 1 9 9 9 - 2 0 0 3 2 0 0 4 - 2 0 0 6 0 50 100 150 200 250 300 350 400 0 1 2 3 4 5 6 7 8 Data Source: EM-DAT: The OFDA/CRED International Disaster Database Economic loss (million USD) Number of events Total Number of Hazards and Economic Losses – R. Macedonia, 1989-2006

17. Country Annual average incidence of major hazards DroughtEarthquake Flood related Wind storm Techno- logy related Albania 0.120.090.240.06 Bosnia and Herzegovina 0.17X0.280.17 Bulgaria 0.210.150.270.15 Croatia 0.280.060.220.17 Macedonia 0.17X0.220.11 Serbia and Montenegro 0.170.060.500.56 Source: Annual average incidence and death computed using EM-DAT, exposed population UNDP Annual Average Disaster Incidence and Major Hazards

18. Country Annual average of deaths due to all hazards Exposed population DroughtEarthquakeFloods Albania 7.82NA155,688131,704 Bosnia and Herzegovina 3.7271397NA Bulgaria 6.64325,406NA275,537 Croatia 8.61NA30,928108,929 Macedonia 13.39NA 17,784 Serbia and Montenegro 10.00NA 321,934 Source: Annual average incidence and death computed using EM-DAT, exposed population UNDP Disaster Vulnerability and Major Hazards

19. Disaster Impact Ranking Country Disaster ranking Disaster impact ranking Cumulative rank Albania1059 Bosnia and Herzegovina365 Bulgaria587 Croatia958 Republic of Macedonia444 Moldova836 Romania222 Serbia753 Montenegro753 Slovenia6710 Turkey111

20. Risk assessment Country12345 AlbaniaSNSNN BiHNNNNS BulgariaNNNNS CroatiaSSNNS MacedoniaNNNNN Country12345 AlbaniaNNSSG BiHNNUNS BulgariaNNSNS CroatiaNNSNS MacedoniaNNSSS Emergency preparedness 1.Emergency response planning 2.Exercises 3.Public awareness 4.Communication & information management systems 5.Technical emergency Response capacity Institutional capacity building 1.Decentralized emergency management system 2.Sommunity participation 3.Legislative framework 4.Training, education & knowledge sharing 5.International cooperation Risk mitigation investments 1.Warning and monitoring systems 2.Hazard mapping and land-use planning 3.Code refinement and enforcement 4.Hazard-specific risk mitigation Catastrophe risk financing 1.Ex-ante funding arrangements 2.Catastrophe insurance pool 3.Reserve funds 4.Contingent capital facility Country1234 AlbaniaNNNS BiHNNNN BulgariaNNNN CroatiaSNNN MacedoniaSSNS Country1234 AlbaniaNNNN BiHNNNN BulgariaNNNN CroatiaNUNN MacedoniaNNNN G Good S Satisfactory N Needs improvement/not available U Under construction

21. Is Disaster Preventable? Nobody died of “disaster” People died of simple to treat and easy recognized conditions Health consequences of disasters are potentially catastrophic and preventable The preparedness is crucial!