Disaster Epidemiology Lessons From Bam Earthquake

1. Disaster Epidemiology Lessons From Bam Earthquake Dec 26, 2003 Iran Part 7: Health sector in Bam earthquake A. Ardalan MD, MPH, PhD student in Epidemiology 1

2. Learning objectives: • To view the structure of health system in Bam • To understand the barriers of efficient health services delivery in Bam • To learn about mental health interventions in Bam • To learn about surveillance system in Bam • To learn about health related concerns in Bam 2

3. Geographic classification Strategies for service delivery Physical space Instruments Health service structure Workforce composition Workforce tasks Duration of activities Workforce training Volunteer peoples 3

4. Population movement after the earthquake   Zones   Earthquake-stricken area 4

5. Population Movement Major concern and barrier for effective services delivery in Bam • Invasion of poor people from neighboring • areas to Bam 110,000 Population beforethe earthquake 90,000 Population at the1.5 months after the earthquake 40,000 Number of death = (?) - 5

6. Population Movement 2) Changing living places inside the bam The most important reasons: • Poor environmental health condition of previous living zone (85%) • Lack of accessibility to latrines (73%) • Recurrent referral of health personnel for census (54%) • Being interested in being in front of their own damaged house (49%) • Lack of sufficient environmental space for living (26%)

7. Cumulative percent of the first time health services delivery to the earthquake-stricken households in Bam till 20th days of post-disaster period 7

8. The overall satisfaction of the earthquake-stricken people from health services delivery 8

9. The needs (expressed demands) of Bam earthquake-stricken households on 19th and 20th days of post-disaster period Bath room 74 % Food 69 % Clothes 68 % Heaters 62 % Security 60 % Latrine 49 % Money 47 % Others 9

10. Illness % Acute respiratory infection 60 Depression 51 20 Oral & teeth problem Nausea / Vomiting 15 Movement disability 13 Irregular menstrual bleeding 10 Addiction 10 The frequency of illnesses in the earthquake-stricken households till 19th and 20th days of post-disaster period 10

11. The needs (expressed demands) of Bam earthquake-stricken householdson19th and 20th days of post-disaster period 11

12. Main barriers in health services delivery in Bam earthquake-stricken households, during first 20 days of post-disaster period Transportation Unavailability of required services Unfamiliarity with health and medical centers Dissatisfied from previous services Inappropriate time 12

13. Some points about accommodation status of population • Determinants of aggregation places • Distances of tents • Risk of injuries • Cultural values 13

14. Social problems of earthquake-stricken households in Bam till 20th days of post-disaster period Violence: Physical or psychological aggression 14

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16. Substance abuse in Bam • Opium abuse • Prevalence before the earthquake: 30 % male, 5% female(anecdotal evidence) • Norm culture • A major problem in the treatment of hospitalized patients 16

17. Changing the pattern of substance abuse in Bam Inadequate withdrawal services Security concern Opium odor Heroin Injection High price of opium Lack of money Psychological consequences of earthquake Low price of heroin Unemployment 17

18. Psychological Problems in Bam earthquake • A major consequence of disaster: 40% PTSD • Comprehensive Mental Health program by Office of MH at MOH • MH and Social Working interventions by State Welfare Organization 18

19. Mental health interventions in Bam • Office of Mental Health at Iranian MOH has valuable experiences on MH interventions in disaster situations, based on previous earthquakes in Iran. • They are covering all population in Bam by holding “Relief groups” to deal with PTSD, Depression and Suicide. 19

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23. Public address system: Psychological importance • Between families had asked for news about their relatives after the earthquake and used from provided list by governmental organization, 23% had found their response. 23

24. Mass Graves in Bam Myths and Realities • Political environment • Bad odor • Cultural beliefs 24

25. Surveillance System Collection of additional data  Modify the system Current response Additional analyses Iterative process Evaluation the action Further action Disseminating the result 25

26. Evaluation of Designing Steps of the Surveillance System in Bam • Establishment of objectives • Development of case definitions • Determining data sources • Development of data-collection instruments • Testing the field • Development and testing of analysis strategy • Development of dissemination mechanism • Usefulness assessmentof system 26

27. Pre-requirements of Surveillance System in disasters Stable health management in crises Epidemiologic Knowledge Well-trained field-team Network communication system 27

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29. Some comments on the Disease Surveillance System in Bam • Necessity of effective training program • Improving effective communication system, especially internet • Surrounding area should not be missed • Integration of a JIT Outbreak Investigation System • Using available data on referrals to clinics and health centers instead of the population for denominator of the indicators accompany by providing necessary information on referral pattern of people. 29

30. Future Potential Risk Factors of Outbreaks in Bam • Hot weather • Re-establishment of pipe-water supplies • Low access to bathing facilities and risk of pediculosis and other cutaneous diseases • Past history of epidemics of typhoid fever and cholera • Endemicity of malaria and coetaneous leshmaniasis 30

31. Final Conclusion of the lecture: • Bam earthquake was a major disaster, resulting in mass destruction and a very high toll on human lives and health. • These losses cannot be justified in light of existing scientific knowledge and expertise in disaster management. 31

32. Final Conclusion of the lecture: • The necessity of research-based information and better multi-disciplinary coordination was evident for more efficient service deliveries to poor people. • Most of what can be done to mitigate injuries must be done before an earthquake occurs. 32

33. Final Conclusion of the lecture: • Because structural collapse is the single greatest risk factor, priority should be given to seismic safety in land-use planning and in the design and construction of safer buildings. • The reconstruction of buildings according to modern standards will take decades to accomplish and will absorb a considerable part of the country's resources. 33

34. Final Conclusion of the lecture: • In disaster-prone areas, training and education in basic first aid and rescue methods should be an integral part of any community preparedness program. • Better epidemiologic knowledge of risk factors • for death and the type of injuries and illnesses • caused by earthquakes is clearly an essential • requirement for determining what relief • supplies, equipment, and personnel are • needed to respond effectively to earthquakes. 34

35. Final Conclusion of the lecture: • The integration of epidemiologic studies with those of other disciplines such as engineering, architecture, the social sciences and other medical sciences is essential for improved understanding of consequences following earthquakes. 35