Public health in the aftermath of disasters

doi:10.1136/bmj.330.7504.1379

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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.

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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 …