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WHO Warns Against Health Misconceptions in Wake of Turkish Earthquake

Numerous "myths" are repeatedly broadcast when a natural disaster occurs: the supposed occurrence of epidemics after disasters, the relationship between dead bodies and epidemics, the need for foreign medical assistance, the need for large quantities of medical supplies and camp hospitals, the need to resettle the population in camps, the need for food aid, a return to normality after a few weeks.

The reality is by far different, Dr Michel Thieren, Medical Officer in WHO's Department of Emergency and Humanitarian Action, warned today. "The demand for health services occurs within the first 24 hours of a sudden event. Most injured people may appear at medical facilities during the first three to five days, after which admitting patterns return almost to normal. Patients may appear in two waves, the first (the great majority) consisting of casualties from the immediate area around the medical facility and the second of referral cases as humanitarian operations in more distant areas become organized. Victims of secondary disasters (post-earthquake aftershocks and fires) may arrive at a later stage."

Eighty-five to 95% of persons rescued from collapsed buildings are rescued in the first 24-48 hours after the earthquake. As a general rule, a week after the impact of the earthquake, the surgical demand and the demand in health care in general is in theory back to normal. Regardless of the number of casualties, the majority of injuries is likely to be minor cuts and bruises, with a smaller group suffering from simple fractures, and a minority with serious multiple fractures or internal injuries requiring surgery and other intensive treatment.

Moreover, Thieren emphasized, natural disasters do not import diseases which are not already present in the affected area and they do not provoke outbreaks of communicable diseases. The risk of an increasing incidence of sporadic cases (below epidemic levels) exists due, in the case of an earthquake, to the rupture of water sanitation infrastructure, the interruption of public health services such as immunization and sanitation measures in urban settings, and the loss of control of disease vectors like mosquitoes and rodents.

Usual post-disaster sanitation measures combined with the strengthening of the disease surveillance system are sufficient for controlling transmission of epidemic-prone diseases.

One of the most common myths associated with natural disasters is that cadavers are responsible for epidemics. In many cases, the management of cadavers rests on the false belief that they represent an epidemic hazard if not immediately buried or burned. In fact, the health hazard associated with dead bodies is negligible. The collection, disposal, burying and/or cremation of corpses requires important human and material resources which should instead be allocated to those who survived and remain in critical condition.

"It is essential that the press and the donor community be aware of what is good practice and malpractice in public health emergency management," Thieren added.

Pending further assessments, appropriate medical assistance in Turkey should target the secondary prevention of crush syndrome among injured cases. This implies that trauma patients need to receive intravenous fluids and that such fluids need to be available in large quantities in the damaged areas. The proper management of severe crush syndrome cases may also require dialysis for renal failure. Hospitals in the country will need considerable capacity to manage such complex trauma patients.

On the other hand, experience has shown that unilateral contributions of certain goods from abroad may be inappropriate and burdensome, and divert donor resources from what is needed most. Examples of what should not be sent from abroad include:

WHO recommends that international contributions be made in cash and not in kind. This ensures that allocation of resources is field-driven by evidence of what is needed on-site.


World Health Organization Department of Emergency and Humanitarian Action
Technical Briefing Note
Public Health Consequences of Earthquakes

Geneva, 18 August 1999

Introduction:

Unfounded information on the public health consequences of natural disaster are commonly disseminated through informal channels of communication and relayed by the press. Numerous "myths" are repeatedly broadcast when a natural disaster occurs. Public health advocacy is essential to re-store the technical information and scientific evidence for combating these "myths" which are misleading donor and inducing misallocation of resources.

Rumors and myths are always the same: occurrence of epidemics after disasters, relationship between death bodies and epidemics, need of foreign medical assistance, need of large quantity of medical supplies and camp hospitals, need to resettle population in camps, need of food assistance, things are back to normal after a few weeks.

Immediate Health Problems Related to Earthquakes

A week after the impact of the earthquake, the surgical demand and the demand in health care in general is in theory back to normal. Late arrival of referred patients and injuries due to secondary disasters may occur. Little information is available about the kind of injuries resulting from earthquakes, but regardless of the number of casualties, the broad pattern of injury is likely to be a mass of injured with minor cuts and bruises, a smaller group suffering from simple fractures, and a minority with serious multiple fractures or internal injuries requiring surgery and other intensive treatment. The demand for health services occurs within the first 24 hours of an event. Injured people may continue to appear at medical facilities only during the three to five days, after which presentation patterns return almost to normal. Patients may appear in two waves, the first consisting of casualties from the immediate area around the medical facility and the second of referral as humanitarian operations in more distant areas become organized. Victims of secondary disasters (post-earthquakes replications and fires) may arrive at later stage

Epidemic Risk After Natural Disasters:

Natural disasters do not import diseases which are not already present in the affected area. Furthermore, outbreak of communicable diseases do not usually occur after earthquakes (and after any natural disasters) although the risk of an increasing incidence of sporadic cases (below epidemic threshold) exists. Epidemic risk factors in the aftermath of an earthquake are the rupture of water sanitation infrastructures, the interruption of public health services such as immunization among children, interruption of sanitation measures in urban settings, and interruption of control of vector like mosquitoes and rodents. Usual post-disaster sanitation measures combined with the strengthening of the diseases surveillance system are sufficient for controlling transmission of epidemic-prone diseases.

The management of death bodies after a disasters:

One of the most common myths associated with natural disasters is that cadavers are responsible for epidemics. In many cases, the management of cadavers lays on the false belief that they represent an epidemic hazard if not immediately buried or burned. The collection, disposal, burying and/or cremation of corpses requires important human and material resources which should be indeed allocated to those who survived and remain in critical conditions. In fact, the health hazard associated with dead bodies is negligible. Contamination may occur in very limited cases when the cadavers are in contact with the water system and transmit gastroenteritis. In the case of cholera, cadavers do not usually interfere with the transmission of the disease. Rather, the hygienic measures and the control of water quality for the survivors are essential for controlling the transmission of cholera. Diseases transmitted by mosquitoes such as malaria and dengue are not associated with the presence of cadavers. A relationship between cadaver and epidemics has never been scientifically demonstrated or reported. However, the scientific argument cannot override both the cultural obligation to take care of dead bodies and the mental health consequences that open mass graves and uncollected bodies produce on the population.

Most Appropriate Contributions for the situation in Turkey:

Secondary Prevention and management of Crush Syndrome cases:

The incidence of injuries and the mortality due to earthquake depends on several factors. In the case of Turkey aggravating factors are the time of day of the event, structural factors, fire risks, number and intensity of aftershocks, demographic characteristics, lag time for rescue. The earthquake occurred in the middle of the night in urban settings where retrofitting measures are not present to reduce vulnerability. The toll of injuries prolonged by long entrapment conditions in collapse building may induce in a significant number of victims a crush syndrome (serious medical complication that follows unattended traumatic injuries). These conditions are met in Turkey and the incidence of crush syndrome complication among victims may be high. Pending on further assessments that are ongoing in Turkey at the moment, an appropriate medical assistance that can be provided in Turkey should target the secondary prevention of crush syndrome among injured cases. This implies that trauma patients need to received IV fluids and that such fluids need to be available in large quantities in the areas of damages. The management of crush syndrome cases requires dialysis for renal failure. Assessment of hospital capacity in the country will measure the current hospital response capacity for the management of complex trauma patients.

Cash Flow:

A local-based supplying strategy is more efficient than imported assistance. This approach rests on providing at the country level fund obligations to proceed to local purchases of supplies in close monitoring with the rapid health assessment exercises. The direct shipment of untargeted medical supplies to Turkey is not recommended and may lead to an unnecessary duplication of resources already covered by international health NGOs already present in the field. It may also create a humanitarian dependence that may overkill the long-term efforts WHO has successfully invested in emergency preparedness in the region.

Not Appropriate Contributions in General and for Turkey at the moment

August 20, 1999


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This article originating from WHO content does not necessarily reflect the views of UMCOR, GBGM, or The United Methodist Church.

For further information related to this article or the World Health Organization, please contact Gregory Hartl, Office of Press and Public Relations, WHO, Geneva, telephone: (41 22) 791 4458, fax: 41 22 791 4858. Email: hartlg@who.ch or Dr. Michel Thieren, Medical Officer, Department of Emergency and Humanitarian Action, WHO, Geneva. Tel: (41 22) 791 4626. Fax: (41 22) 791 4844. E-Mail: Thierenm@who.ch All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.ch. This article is at http://www.who.org/inf-pr-1999/en/pr99-42.html. Copyright © WHO/OMS.