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Nepal earthquake gives rise to fears over poor sanitation

BMJ 2015; 350 doi: (Published 06 May 2015) Cite this as: BMJ 2015;350:h2430
  1. Anne Gulland
  1. 1London

Aid agencies and health officials are warning that poor sanitation in the aftermath of the Nepal earthquake could lead to an outbreak of waterborne diseases such as cholera and dysentery.

The Disasters Emergency Committee, the body that is coordinating the UK humanitarian response to the earthquake, has warned that in many areas clean water supplies have been disrupted, with people living and defecating in the open.

The World Health Organization said that between 75 and 85 cases of diarrhoea and 200 cases of upper respiratory infection have been reported.

Roderico Ofrin, the regional coordinator for emergency risk management at WHO’s South East Asia regional office, told The BMJ that poor sanitation was a concern. “There are some reports of disease, but we’re not at outbreak levels,” he said. WHO has strengthened public health surveillance and sent local and international staff to work with regional health offices to ensure reporting of disease outbreaks.

Glynnis Brooks, head of health and water, sanitation, and hygiene at the British Red Cross, said that latrines needed to be built immediately. “Water and sanitation remain critical at this stage of the disaster, as those affected are generally much more susceptible to illness and death from disease,” she said. “We are working to ensure that safe water is available to drink, cook with, and use for personal hygiene purposes. This is essential in order to prevent dehydration and water related disease such as diarrhoea and cholera.”

After an initial assessment last week the charity Médecins Sans Frontières, which has more than 120 staff in Nepal, said it was concerned about two makeshift camps, one in the centre of Kathmandu and the other about 40 km from the city. In the Kathmandu camp access to clean drinking water is limited, and the public toilets are overflowing. In the camp outside the city people are collecting rainwater and have no access to toilets.

A team of doctors from the nearby Bir Hospital have set up a makeshift consultation area in the camp in central Kathmandu to manage primary care needs.

The latest figures show that around 7200 people died in the magnitude 7.8 earthquake and that more than 14 122 were injured. Some 4.2 million people have been affected and 2.8 million displaced.

Ofrin said that since last week the number of people reporting to hospital with trauma injury had fallen drastically. “There is now concern about what aftercare can be offered to those with complex fractures, multiple fractures, and spinal injuries,” he said, adding that WHO was in the process of talking to foreign medical teams, particularly those specialising in physical and rehabilitation medicine.

A WHO assessment found that four hospitals were completely destroyed by the earthquake, while 90% of health facilities across the country have been damaged to some extent. Another five hospitals are functioning but are struggling to cope with a large number of outpatients, WHO found. Damaged infrastructure and a shortage of materials such as body bags, tents and mattresses, medical supplies, and essential drugs were also proving “challenging,” said WHO.

Field hospitals are being set up on the site of the four non-functioning hospitals, and the five hospitals most urgently in need of supplies are being sent additional equipment.

WHO has set up a field office in Gorkha district in central Nepal, from where it will coordinate the delivery of medical supplies, healthcare professionals, and other resources to some of the remote regions affected by the earthquake.

Last week the United Nations launched a $415m (€370m; £274m) appeal to provide relief for people affected by the earthquake, which destroyed around 70 000 houses and damaged 530 000 more.

The UN said that emergency health services, medical supplies and facilities, and safe drinking water and sanitation facilities were also urgently needed for up to 4.2 million people.


Cite this as: BMJ 2015;350:h2430

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