DISASTERS – AN INDIAN EXPERIENCE

1. DISASTERS – AN INDIAN EXPERIENCE Prof. Shridhar Sharma MD, DPM, FRCPsy (London) FRANZCP(Australia), DFAPA (USA), FAMS Emeritus Professor National Academy of Medical Sciences & Institute of Human Behaviour & Allied Sciences, Delhi-110 095

2. Disasters are ubiquitous but most large scale disasters occur in cancer and tropic of Capricorn geographical region which encompasses most of the developing nations. • Due to the geography and topography, India has faced serious large scale natural disasters like droughts, cyclones and earthquakes. • The available statistics also show that the number of disasters per year is increasing but also the number of people affected and killed is also rising.

3. Major Disasters in Known History of India

5. Natural disasters • Earthquake: India is having a high risk towards Earthquakes. More than 58 per cent of India’s land area is under threat of moderate to severe seismic hazard. • During the last 20 years, India has experienced 10 major earthquakes that have resulted in more than 35,000 deaths. • Of the earthquake-prone areas, 12% is prone to very severe earthquakes, 18% to severe earthquakes and 25% to damageable earthquakes. • The biggest quakes occur in the Andaman and Nicobar Islands, Kutch, Himachal and the North-East. The Himalayan regions are particularly prone to earthquakes.

7. Earthquake in Gujarat

9. Earthquake

10. Floods: • About 30 million people are affected annually. Floods in the Indo–Gangetic–Brahmaputra plains are an annual feature. • On an average, a few hundred lives are lost, millions are rendered homeless and several hectares of crops are damaged every year. • Nearly 75% of the total rainfall occurs over a short monsoon season (June – September). 40 million hectares, or 12% of Indian land, is considered prone to floods. • Floods are a perennial phenomenon in at least 5 states - Assam, Bihar, Orissa , Uttar Pradesh and West Bengal. • On account of climate change, floods have also occurred in recent years in areas that are normally not flood prone. • In 2006, drought prone parts of Rajasthan experienced floods.

11. Droughts: • Drought is another recurrent phenomenon which results in widespread adverse impact on vulnerable people’s livelihoods and young children’s nutrition status. • About 50 million people are affected annually by drought. Of approximately 90 million hectares of rain-fed areas, about 40 million hectares are prone to scanty or no rain. • Although a slow onset emergency, and to an extent predictable emergency, drought has caused severe suffering in the affected areas in recent years, including effects on poverty, hunger, and unemployment.

12. Cyclones: • About 8% of the land is vulnerable to cyclones of which coastal areas experience two or three tropical cyclones of varying intensity each year. • Cyclonic activities on the east coast are more severe than on the west coast. • The Indian continent is considered to be the worst cyclone-affected part of the world, as a result of low-depth ocean bed topography and coastal configuration. • The principal threat from a cyclone are in the form of gales and strong winds; torrential rain and high tidal waves/storm surges. • More cyclones occur in the Bay of Bengal than in the Arabian Sea and the ratio is approximately 4:1. • An analysis of the frequency of cyclones on the east and west coasts of India.

14. Landslide • In the hilly terrain of India including the Himalayas and North East India, landslides have been a major and widely spread natural disasters that often strike life and property and occupy a position of major concern. • One of the worst tragedies took place at Malpa Uttarkhand (UP) on 11th and 17th August 1998 when nearly 380 people were killed when massive landslides washed away the entire village.

15. Avalanche • Avalanche are river like speedy flow of snow or ice descending from the mountain tops. • Avalanches are very damaging and cause huge loss to life and property. • In Himalayas, avalanches are common

16. Tsunami affected Indian territory

17. TSUNAMI

18. TSUNAMI

19. TSUNAMI

20. CHARACTERISTICS OF NATURAL DISASTERS: LOW SUDDEN HIGH LOW • Earthquakes • Cyclones • Floods • Famine PREDICTABILITY SCOPE ON SET DELAY INITIAL LETHALITY HIGH LOW SLOW HIGH

21. The last century has added a new ecological dimension to the definition of a disaster. • We then have newer man made disasters on our hands which include chemical Disasters like Bhopal Gas Tragedy of 1984, oil spills, air water and soil pollution. • Developing countries have been facing the brunt more than the developed ones because they have less physical and financial resources. • India as the second largest populated country with 1.2 billion population has a large share of all types of disasters.

22. It is virtually impossible to prevent most disaster. • Nevertheless, we can forestall or alleviate many of their worst effect by anticipating them and by being prepared. • The greatest number of disasters occur in those countries that are already most adversely affected by ill-health and poor economic conditions.

23. DISASTER is a collective responsibility requiring coordinated responses from various agencies and all parts of the society. • Government Agencies: • Urban Development • Agriculture & Food • Health • Energy - Power

24. DEATH • DISEASE • DISABILITY • DISTRESS • DISLOCATION • DISORGANIZATION • STARVATION • WATER & POWER SUPPLY • UNEMPLOYMENT • ROADS – COMMUNICATION DISASTERS PRODUCE SEVERAL TYPES OF TRAUMA. THE HEALTH CONSEQUENCES FALL INTO VARIOUS CATEGORIES

25. DISASTER TRAUMA

26. Rescue • Relief • Rehabilitation • Follow-up APPROACHES

27. THE PSYCHOLOGICAL RESPONSE TO DISASTER WILL DEPEND ON THREE MAIN FACTORS: • THE DISASTER: - OCCURRENCE • MAGNITUDE • SUDDENNESS • TYPE • THE COMMUNITY - LEVEL OF PREPAREDNESS • - SOCIAL SUPPORT • LEADERSHIP • PAST EXPERIENCE • THE VICTIMS: • AGE • LEVEL OF EDUCATION/EXPOSURE • MARITALSTATUS • PHYSICAL HEALTH DISASTER MAGNITUDE RESPONSE VICTIM COMMUNITY

28. The key issues are: • Quick assessment Immediate response • Quick Planning Coordination • Quick Execution or action Desired result SPEED & DIRECTION ARE KEY ISSUES

29. The target population is primarily normal • People do not disintegrate in response to disaster. • People respond to active interest and concern. KEY CONCEPTS

30. Traumatized individuals are resistant to seeking treatment So treatment must be taken to survivors. Victims of flood, earthquakes and hurricanes Increased Prevalence of: PTSD Depression which are risk factors for suicidal thinking suicide rate increases need for mental Health support after severe disasters.

31. Morbidity represents a cluster of diseases involving more than one target organ. • Exposure levels are difficult to establish • Environmental Monitoring may have limitations. • Biological Monitoring may not be feasible.

32. Community as a Resource • Need for Joint preparation • Need to develop • Single function but develop Joint training • Multidisiplinary service model Joint training • A chain is as strong as its weakest link

33. Crucial rehabilitation process. • The first objective is to get water, Food, Electricity and Sewerage system restored plan temporary housing up in a few weeks so that the people can move out of the schools. • Long term housing is essential to use locally available material that are suitable for the climate and culture. • Getting people to build their own houses has a two-fold purpose. • It provides the people with an income, it gets them involved and interested in the design and construction of their houses and this participatory approach gets them out of the depression and lethargy that follows trauma. GUIDELINES

34. There is a need for institutionalization of process for learning from experiences obtained from Disaster • Creation of information and Data clearing house on Disaster management • Creating a knowledge centre in each Locality • Readiness and develop strategies and intervention. • Act on lessons learned from evidence based research and practical experience (fire in building lift staircases, Drowning.- Safety ships tanks- Bhopal Gas tragedy

35. Longitudinal analysis of earth quake-victims Factor 1 - Fear anxiety-appear earlier and decreased earlier Factor 2 - Depression & Physical symptoms appeared later & stayed longer. Factor 3 - Psychosocial problems gradually decrease as time passed by

36. PHASEACTIVITY (BEFORE THE DISASTER) 1. Hazards : Identification of hazards : Identification of vulnerabilities. : Assessment of risk 2. Prevention : Removal of the hazard : Selection of alternatives : Hazard control 3. Planning : Contingency planning mitigation : Knowledge of rehabilitation methods : Instituting organizational framework TABLE : COMPONENTS OF CHEMICAL DISASTER PREPAREDNESS

37. PHASEACTIVITY (AFTER THE DISASTER) Emergency : Accurate response : Speed of Action Follow-up : Knowledge of chemicals(s) : Fencing of the accident : Diagnosis of needs : Implementation : Monitoring : Feedback and adjustment : Information transfer & storage TABLE : COMPONENTS OF CHEMICAL DISASTER PREPAREDNESS

38. Therapeutic approaches in survivors of Disaster Common Psychiatric response to Disaster: 1. Acute stress Disorder 2. Anxiety, fear and Panic 3. Depression 4. PTSD 5. Substance Abuse 6. Somatization Disorders 7. Adjustment disorder 8. Organic mental disorder, injury, toxins etc.

39. Mental health personnel constitute a very valuable resource. • They should not only be included in the design of a disaster plan but also interacted into the disaster response team. • Mental health care must receive special attention and be frequently updated for the population living in disaster prone areas. • A plan must be prepared for all situations. • In order to help victims in distress, mental health specialists must design short and long term training programs depending on the level of knowledge and skills of the staff, and implement them. • In the immediate aftermath of a disaster, both health and relief workers need a quick and flexible orientation. • This training session must be planned before the disaster impact.

40. DIMENSIONS OF MENTAL HEALTH • The field of mental health includes three sets of objectives. • One of these has to do with mentally ill person s. For them the objective is the restoration of health. • A second has to do with those people who are mentally healthy but who may become ill if they are not protected from conditions that are conductive to mental illness, which however are not the same for every individual. The objectives for those persons is prevention. • The third objective has to do with the upgrading of mental health of normal persons, quite apart from any question of disease or infirmity. This is positive mental health. It consists in the protection and development at all levels, of human society of secure, affectionate and satisfying human relationships and in the reduction of hostile tensions in persons and groups.

41. India had enough experience in dealing with natural disasters. • The lessons that we learnt from the Orissa cyclone of 2000, the Gujarat earthquake of 2001 and other disasters have helped us effect a paradigm shift in our approach to disaster management proceeding from the conviction that development cannot be sustainable unless disaster mitigation is built into the development process at all levels. HOPE: INDIA CAN DEAL WITH THE CRISIS

42. Strategic Plan • Need to build a national hub to share and learn and to create a critical mass of institutions, trainers and trained professionals.

43. Every calamity presents an opportunity to equip themselves to face with greater confidence and competence, similar challenges in the future.

44. Disasters disrupt progress and destroy the outcome of developmental efforts over several years, often pushing nations in quest for progress back by several decades. • Thus, efficient reduction of disaster risks, rather than mere response to their occurrence, has in recent times, received increased attention both within India and abroad. • With a vision to build a safe and disaster resilient India, the Government has adopted a holistic, proactive, multi-hazard oriented and technology driven strategy by promoting a culture of prevention, mitigation, preparedness and response.

45. THANK YOU