Public health in the aftermath of disasters

doi:10.1136/bmj.330.7504.1379

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Eric K Noji, senior medical officer

Introduction

In the aftermath of disasters, public health services must address the effects of civil strife, armed conflict, population migration, economic collapse, and famine. In modern conflicts civilians are targeted deliberately, and affected populations may face severe public health consequences, even without displacement from their homes. For displaced people, damage to health, sanitation, water supplies, housing, and agriculture may lead to a rapid increase in malnutrition and communicable diseases.

Fortunately, the provision of adequate clean water and sanitation, timely measles immunisation, simple treatment of dehydration from diarrhoea, supplementary feeding for the malnourished, micronutrient supplements, and the establishment of an adequate public health surveillance system greatly reduces the health risks associated with the harsh environments of refugee camps.

The Indonesian city of Banda Ache, Sumatra, after the devastating tsunami on 26 December 2004

Critical public health interventions

Environmental health

Overcrowding, inadequate hygiene and sanitation, and the resulting poor water supplies increase the incidence of diarrhoea, malaria, respiratory infections, measles, and other communicable diseases. A good system of water supply and excreta disposal must be put in place quickly. No amount of curative health measures can offset the harmful effects of poor environmental health planning for communities in emergency settlements. Where camps are unavoidable, appropriate site location and layout and spacing and type of shelter can mitigate the conditions that lead to the spread of disease.

View this table:

In this window
In a new window

Table 1

Priorities for a coordinated health programme for emergency settlements

Water supply and sanitation

Adequate sources of potable water and sanitation (collection, disposal, and treatment of excreta and other liquid and solid wastes) must be equally accessible for all camp residents. This is achieved by installing an appropriate number of suitably located waste disposal facilities (toilets, latrines, defecation fields, or solid waste pick-up points), water distribution points, availability of soap and bathing and washing facilities, and effective health education.

The United Nations High Commissioner for Refugees (UNHCR) recommends …