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

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

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

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

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

Macedonia 48,8 % China Rep India 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 Zimbabwe Philippines Mexico Pakistan Veit Nam Columbia Zambia Swaziland 35,4% Geophysical Climatological Hydrological Meteorologic top countries by victims/ in 2007 Legend:

Disasters in Europe by Victims/ Inhabitant

EM-DAT: The OFDA/CRED International Disaster Database –

Disaster Profile of the Republic of Macedonia EM-DAT: The OFDA/CRED International Disaster Database –

Disaster Profile of the Republic of Macedonia

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

Distribution of Different Hazards and Trends – R. Macedonia,

Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Number of deathsNumber of events Total deathsTotal events Hazard Incidence and Number of Deaths, Each Hazard- R. Macedonia,

Hazard Incidence and Total Number of Victims, Each Hazard - R. Macedonia, Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Number of victims Number of events Total victimsTotal events

Drought Epidemic Extreme temperature Flood Transport Accident Wildfire Windstorm Economic loss (million USD) Number of events Total economic lossTotal events Hazard Incidence and Economic Lost due to All Hazard - R. Macedonia,

Total economic damages reported (2003 US$ million) Total number of hazards (natural and technology) 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,

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

Country Annual average of deaths due to all hazards Exposed population DroughtEarthquakeFloods Albania 7.82NA155,688131,704 Bosnia and Herzegovina NA Bulgaria ,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

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

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

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!