DISASTER MANAGEMENT AND PUBLIC HEALTH

EXPERIENCE IN THE AFTERMATH OF THE

EARTHQUAKE AT BHUJ IN INDIA

Dr HS Ratti, MD

India

DATE LOCATION MAGNITUDE 1819 JUN 16 KUTCH,GUJARAT 8.0 1869 JAN 10 NEAR CACHAR, ASSAM 7.5 1885 MAY 30 SOPOR, J&K 7.0 1897 JUN 12 SHILLONGPLATEAU 8.7 1905 APR 04 KANGRA, H.P 8.0 1918 JUL 08 SRIMANGAL, ASSAM 7.6 1930 JUL 02 DHUBRI, ASSAM 7.1 1934JAN 15 BIHAR-NEPALBORDER 8.3 1941 JUN 26 ANDAMAN ISLANDS 8.1 1943 OCT 23 ASSAM 7.2 1950 AUG 15 ARUNACHAL PR – CHINA BDR 8.5 1956 JUL 21 ANJAR, GUJARAT 7.0 1967 DEC 10 KOYNA, MAHARASHTRA 6.5 1975 JAN 19 KINNAUR, HP 6.2 1988 AUG 06 MANIPUR-MYANMAR BORDER 6.6 1988 AUG 21 BIHAR-NEPAL BORDER 6.4

DATE LOCATION MAGNITUDE DEATH INJURED

• 1991 OCT 20 UTTARKASHI, UP HILLS 6.6 769

• 1993 SEP 30 LATUR- 6.3 7601 16000

• 1997 MAY 22 JABALPUR,MP 6.0 39

• 1999 MAR 29 CHAMOLI DIST, UP 6.8 103

SIGNIFICANT EARTHQUAKES IN INDIA AND ITS NEIGHBOURHOOD (1801 - 2000)

ANTICIPATED PUBLIC HEALTH PROBLEMS IN DISASTERS

1 Disruption of Water supply and Sanitation

2 Large scale migration

3 Overcrowding due to emergency housing situations with poor personal hygiene

4 Mass feeding without adequate food handling, storage and sanitary facilities

5 Disposal of Dead Bodies and Caracas

6 Rodent and Stray dog/animal problems

7 Relaxation of sterilization precautions and emergency use of unscreened blood

8 Psycho-social and Mental health problems

COMMUNICABLE DISEASES HAVING DISASTER IMPLICATIONS (HAVING POTENTIAL FOR OUTBREAK)

1.Amoebiasis

2.Camplyobacter Enteristis

3.Chicken Pox

4.Cholera

5.Coccidiomycosis

6. Dengue fever

7.Diptheria

8.E. Coli Diarrhoea

9.Food Poisoning

10.Rotavirus Enteritis

11.Hepatitis A, B & E

12.Hanta Virus Disease

13.Influenzae

14. Leptospirosis

15. Malaria

16. Measles

17. Meningitis

18. Pertusis

19. Plague

20. Pnuemococcal Pneumonias

21. Rabies

22. Relapsing Fever

23. Salmonellosis

24. Scabies

25. Typhoid Fever

26 Jan 2001 at 0856 AM (IST), Bhuj in western India and its surrounding areas were struck with severe earthquake, measuring 7.9 on the Richter scale

CRATER FORMED AT THE EPICENTRE AT DHORI

LINEAR CRACK AT THE EPICENTRE AT DHORI

LAVA LIKE MATERIAL SPROUTED AT THE EPICENTRE

DESTRUCTION LEFT BEHIND BY THE EARTHQUAKE

Mortality and Morbidity

• Dead 19727

• Injured 1,66,000

• Homeless 6,00,000

• House Destruction total : 3,48,000

• House Destruction partial : 8,44,000

• Total cattle Killed : 20,000

• Direct Estimated Economic Loss :USD 1.3 bn

• Large scale migration of inhabitants

• Large scale scale influx of relief workers & material

• International NGOs : 55• National /Local NGOs : 26• Government Bodies : 8• Donor Governments :18• Inter Governmental Organisations :8• Red Cross and Red Cresent :6• Total Organisations (2 weeks) :125

Relief Agencies at work

• Immediate 48-72 hrs Relief and Rescue provided by Indian Army Teams and the Indian Army Hospital

• 12000 surgical operations performed in makeshift Military Hospital within first 60 hrs of the Disaster

• Situation Assessment

• Public Health Measures–Water Borne disease– Air Borne infections– Vector borne diseases– Biomedical wastes– Disease Surveillance – Dead Bodies and Animal Caracas Disposal– Disinfecting of Rescue Sites and Teams–Mental Health

Public Health Measures

CLIMATIC CONDITIONS PREVAILING IN BHUJ IN FIRST WEEK OF FEB 2001

Max Min

Day Time 330 C 220 C Avg Temp 210C

Night Time 190 C 090 C

RH 72 61

Rainfall Nil Gujarat State has experienced Drought Conditionssince 1998

Water Borne disease• Threat potential–Breakdown of distributed piped water supplies

and water requirement being met from alternate sources

–Drinking water available only from 4 to 5 deep bore wells scattered over the whole town and nearby villages in the Public Health Engineering Department.

–Drinking water is highly salty and at places turbid (due to earthquake).

– The water is collected by water truck/water bowsers/tankers and distributed manually

• Intervention– The bore well water is collected in sump.

– Flocculation and sedimentation in the sump was carried using Alum for a period of atleast 4 hours

– It is followed by super chlorinating at 2 ppm with liquid chlorine and/or bleaching powder with a contact period of minimum 20 minutes

– All water bowsers/tankers leaving the water point were checked for free chlorine levels and due records were kept.

Water Borne disease

Water Borne disease•Outcome– 70 to 75 percent of population was getting chlorinated water supply.

– A 8000 litre desalination plant received as gift from USAID was installed for exclusive issue of drinking water.

–There were no cases of Gastro Intestinal diseases among population in 3 week post disaster period.

–A close monitoring has been instituted combined with disease surveillance

• Threat potential

– All pers and families living in tentage and makeshift

arrangements

– Inadequate supplies of tentage resulting in

overcrowding by a factor of 80 to 100 percent.

– Sharp and high difference in max and min temp

(max daytime temp of 34 to 36 degrees centrigade

while min night temp was 8 degrees centigrade)

– Season ideal for Chicken pox, measles and

meningitis outbreaks

– Potential of outbreak of Bubonic plague was kept in

mind in view of earthquake disaster

Air Borne disease

• Intervention– Health education campaign was undertaken to ensure

that there was minimal over crowding in tentage accommodation. A minimum distance of 3 feet was advocated

– To adopt a head-foot alternate bed positions

– Adequate ventilation of tentage and exposure to sun during daytime was adovacated

– Provision of adequate warm clothing

– Field and Hospital based Passive Disease surveillance

– Active surveillance by random interviews was carried out in select areas of high density. Every day, a new area was visited. Health advice was given.

Air Borne disease

• Outcome– There were 4 cases (all adult males) of chicken

pox reported between 7 to 8 Feb in military areas and 31 cases among civil population in samkhayali village near Bachao. Of these, 28 were children under 12 years of age and 3 adults

– Outbreak control measures included segregation and symptomatic treatment of the affected individuals

– All cases recovered and no secondary outbreak of communicable diseases was reported in military and civil areas till 3 weeks after last case

Air Borne disease

• Threat perception–No piped distribution of water supply

leading to places with water point collection

– Inadequate disposal of liquid and solid wastes leading to fly nuisance

– Inadequate disposal of Bio Medical waste

Vector Borne disease

• Intervention– Spraying operations using 0.1 % NUVAN (Dicholorvos)

solution in the areas where solid waste were disposed

– Daily sprinkle of Lime Slaked powder over and around the Deep Trench/Shallow Trench latrines used for excreta disposal in temperory shelters put up for living

– ‘Smoking’ of the Deep trench latrines to prevent and fly breeding

– Spray water collection pockets with anti larval measures - Baytex 1000 Conc and/or Baytex granules or Abate (Temephos 0.5%)

– Space spraying of tentage accommodation with Baygon and /or Malathion 50 % EC (in 0.5 % solution)

Vector Borne disease

• Large quantity of Biomedical waste was generated in the areas in military hospital and other places in whole of district of Bhuj following disaster.

• No incineration facilities are available except in the military hospital where rudimentary and sufficient facilities are available only for routine workload

• The waste was segregated into open pits at a distance from the hospital and burnt in the beehive incinerator over a period of 7days

• Other non biodegradable waste like plastics, IV Sets, were disposed by deep burial in open ground

• Biological medical waste generated in other areas including animal dead was strewn all around in Bhuj district and posed a potential public health problem

Bio Medical Waste

Disease Surveillance• Active Disease

surveillance in 10 relief centres were established in and around Talukas of Bhuj district - Khavda, Anjar, Baccaho (2 centers), Samkhyali, Ratanpol, Modvadar, Dhori, Dharan and Mandvi.

• Passive Disease surveillance launched in consultation with WHO Teams and the State Health authorities

•Each relief centre had a team of one Medical Officer and Two Nursing Assistant. Besides, additional Mobile Teams from each centre were sent out daily to cover different villages.•No mass immunisation was recommended. However, UNICEF promoted mass vaccination against measles for all children 9 mths - 5 yrs was undertaken in the the Kutch areas by the state health authorities

Disinfection of Rescue Sites and Teams

• Personal Protective Measures– Gloves, Face Masks and

Head Protection

• Disinfecting The Dead Bodies with 40% Formalisn and 10 % Creosol Solution

• Deodourisation of the work are at the relief site

MENTAL HEALTH

A much relieved lady rescued after 96 hours.

•Acute Post Stress Disorder

•In need of Post Traumatic Counseling

REHABLITAION & RECONSTRUCTION

First steps towards future ?