Emergency and humanitarian action in the wake of a natural disaster
Manila, 16 May 2008—There is a widespread and erroneous belief that dead bodies are a source of disease and therefore a threat to public health. This is untrue. There has never been a documented case of a post-natural-disaster epidemic that could be traced to dead bodies.
Those killed by natural disasters are generally healthy at the time of their death, and therefore very unlikely to be a source of infection to others. The micro-organisms responsible for the decomposition of bodies are not capable of causing disease in living people. Most infectious agents of public health concern that may be present at the time of death will themselves die within hours of the person dying. Generally, for an epidemic to occur, certain necessary conditions related to infectious agents, susceptible hosts and a favourable environment have to be met. If any of these conditions is not present, an epidemic cannot occur.
However, epidemics certainly can occur in the period after a disaster. The peak danger period is between 10 days and one month after the event. Unsafe food and a lack of access to safe water, facilities for personal hygiene and safe sanitation arrangements all create a real risk for outbreaks of infectious disease at any time, but after a disaster these conditions, added to large numbers of people in overcrowded temporary shelters, heighten the danger. It is how the survivors are managed, rather than how the dead are managed, that determines if and when an epidemic may occur.
Certain diseases, such as HIV and hepatitis, pose a potential risk for individuals who come into close contact with dead bodies, but not for the general public. Those assigned any roles associated with handling dead bodies and body parts should be properly trained and always use protective equipment.
Overall, care of the dead is not a primary health sector responsibility. There is no public health threat from dead bodies and this misapprehension causes unnecessary diversion of staff and resources at a critical time. Pressure from misinformed journalists and media organizations can cause governments to behave inappropriately, for example spraying the area around dead bodies with disinfectant or covering dead bodies with lime. These operations are costly, time consuming, require complicated logistics and coordination, take staff away from caring for survivors and are totally unnecessary.
It is very important for the psychological recovery of survivors to have their dead relatives returned to them for culturally appropriate rites and disposal.
Myths and realities
Myth: Foreign medical volunteers with any kind of medical background are needed.
Reality: The local population almost always covers immediate life-saving needs. Only medical personnel with skills that are not available in the affected country may be needed.
Myth: 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.
Myth: The affected population is too shocked and helpless to take responsibility for their own survival.
Reality: On the contrary, many find new strength during an emergency, as evidenced by the thousands of volunteers who spontaneously unite to assist in search and rescue operations.
Myth: Disasters are random killers.
Reality: Disasters strike hardest at the most vulnerable group, the poor – especially women, children and the elderly.
Myth: Locating disaster victims in temporary settlements is the best alternative.
Reality: It should be the last alternative. Many agencies rightly use funds normally spent for tents to purchase building materials, tools, and other construction-related support in the affected country.
Myth: Things are back to normal within a few weeks.
Reality: The effects of a disaster last a long time. Disaster-affected countries deplete much of their financial and material resources in the immediate-post-impact phase. Successful relief programmes gear their operations to the fact that international interest wanes as needs and shortages become more pressing.
Transmission of diseases
Population displacement, crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe food preparation and handling practices are all associated with transmission of waterborne and foodborne diseases.
Immediate intervention for communicable disease control
Water and sanitation
- Ensuring uninterrupted provision of safe drinking water is the most important preventive measure in reducing the risk of outbreaks of waterborne diseases. Key messages on hygiene should be promoted (eg. washing hands).
- Waste should be disposed of in a pit.
- Take care that survivors do not defecate or urinate in or near a source of drinking water.
- Do not wash yourself, your clothes, or your pots and utensils in the source or the site dedicated for fetching drinking water (stream, river)
- Buckets used to collect water should be hung up when not in use and not left on a dirty surface.
- Do not allow refuse and stagnant water to collect around a water source.
Shelter and planning
- Whenever possible, shelters for the displaced and homeless must have sufficient space between them to prevent diseases related to overcrowing or lack of ventilation, such as measles, acute respiratory infection, diarrhoeal diseases, tuberculosis and vector-borne diseases.
Management of malnutrition
- Infants born into populations affected by the emergency should start breastfeeding within one hour of birth and continue to breastfeed exclusively (not even water) until six months of age. Infants who are not breastfed are vulnerable to infection and diarrhoea.
- Priority must be given to providing emergency medical and surgical care to people with injury-related conditions.
- Patients should be categorized by severity of their injuries and treatment prioritized in terms of available resources and chanced of survival.
- Open wounds must be considered as contaminated and should not be closed. Removal of dead tissue is essential which may necessitate a surgical procedure undertaken in appropriate conditions. After removal of dead tissue and debris, wounds should be dressed with sterile dressings and the patient scheduled for delayed primary closure.
- Patients with open wounds should receive tetanus prophylaxis.
- Whenever possible, search and rescue workers should be equipped with basic protective gear such as footwear and leather gloves.
- HIV post-exposure prophylaxis kits should be available to health-care workers, rescue workers in case of accidental exposure to contaminated blood and body fluids.
For more information: http://www.who.int/hac/en/index.html
For further information, please contact Dr Arturo Pesigan, WHO Technical Officer, Emergency and Humanitarian Action in the Western Pacific Region, at (632)5289810 or email: email@example.com