October 11, 2005
Dr. Philippe Guérin, scientific director of Epicentre, a nonprofit epidemiological research partner of Doctors Without Borders/Médecins Sans Frontières (MSF), states that natural disasters do not cause epidemics. He details the risks and priorities in the wake of the Kashmir earthquake, as he had done after the Tsunami.
In medical terms what are the consequences of a natural disaster such as the earthquake in Kashmir?
The immediate impact of a natural disaster is the huge number of victims. The dead, of course, but also the injured who have to be treated as quickly as possible. People are suffering from cuts and fractures and, if there is no treatment, their wounds can quickly become infected as a result of these difficult conditions. In the specific case of an earthquake, people can also suffer from what is known as "crush syndrome." This happens when a person, for example, has been caught under a collapsed building for several hours, enduring high pressure on their muscle tissues that can lead to kidney failure.
The earthquake has destroyed houses and infrastructures, in particular drinking water supply systems (wells, pipes etc.). The destruction of homes often means that people are being displaced and forced to regroup themselves in very makeshift conditions. This is the biggest risk in health terms: forced overcrowding, insufficient access to drinking water, and medical treatment, and, in the near future, food.
These circumstances can result in disease and encourage the spread of common infectious diseases. Sleeping outdoors and in makeshift shelters, people can contract respiratory infections, especially children. After the earthquakes in Afghanistan in the late 1990s, or in Bam (Iran) in December 2003, the vast majority of MSF consultations involved respiratory infections. This is particularly true in the high altitude region of Kashmir, where weather conditions are bad. Within two weeks, winter will begin with the first snows. There is also a risk of diarrhea-related diseases as a result of consumption of contaminated water. In Pakistan, shigellosis (a dysenteric disease) can be a specific problem.
But it is untrue to think that a natural disaster itself leads to a wave of epidemics. Our experience with natural disasters proves that they do not lead systematically to epidemics. Once more, after the tsunami in South Asia, doom-mongers predicted massive epidemics. But once more, nothing of the sort happened.
It is also important to point out that bodies themselves are not vectors for spreading diseases. For the survivors, the priority in public health terms is access to decent shelters, drinking water, and medical treatment. Of course, bodies have to be collected, but that is more for psychological reasons in these circumstances.
On the other hand, in the case of certain specific pathologies like cholera or malaria, they already have to exist in the countries concerned for there to be a risk of an epidemic. In Kashmir, a mountainous zone, there is no malaria. As for cholera, since it is present in the region, a close surveillance system has to be put in place in order to monitor for any outbreaks of isolated cases. Then we need to be ready to react so that we can treat the sick and stop the spread of disease. Measles cases will also have to be kept under watch, as the vaccination coverage is probably low in this region.
The risk of epidemics is not directly linked to the earthquake, as experience and scientific literature demonstrates. Isolated outbreaks may happen, but they result rather from the poor living conditions in destroyed areas. Epidemiological surveillance and medical treatment should prevent them from degenerating into widespread epidemics.
What is the role of a humanitarian medical organization such as MSF in a catastrophe such as this one?
First of all, assessing the needs on a case-by-case basis. The situations vary significantly from village to village, according to the level of destruction and number of the injured. The already fragile health systems will likely be temporarily overwhelmed by the influx of injured. Furthermore, within any country, there are always segments of the population that may be overlooked during the initial emergency response, and MSF will try to focus assistance on these neglected groups.
MSF may be asked to intervene in various ways. Sometimes we can help to take care of the injured, where there is a need for this. But caring for the injured takes place during the first few days of an emergency, and nongovernmental organizations often arrive too late for that. The wounded are mostly taken care of by local doctors sent from unaffected zones of the country hit by a disaster. So the main part of our action will be to ensure access to treatment, emergency distributions of shelters and blankets, and water supplies for the populations affected by the disaster. In the short term, this should lead to an improvement in their living conditions and limit the mortality rate in the event of the appearance and spread of diseases. Finally, MSF can participate in the epidemiological surveillance effort, and react quickly if an outbreak occurs.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)