Intended for healthcare professionals

Rapid response to:


Disease threatens millions in wake of tsunami

BMJ 2005; 330 doi: (Published 06 January 2005) Cite this as: BMJ 2005;330:59

Rapid Response:

Need for Post-Disaster HIV/AIDS Prevention

According to the World Health Organization’s 1998 statement, the world was comforted that there were effective early warning systems in place for climate change, problems with food production, aerial attacks, and a developing international effort in infectious disease control and management.1 Yet there was no Tsunami alert. Hence, more than 150,000 people were killed and millions others are facing unimaginable devastation including not only the loss of loved ones, but also the lack of basic necessities of life such as food, shelter, medicines along with the looming threat of infectious diseases.

From the medical standpoint, disaster situations are characterized by an acute and unforeseen imbalance between the capacity and resources of the medical profession and the needs of the victims or the people whose health is threatened, over a given period of time.2 There is no doubt in anyone’s mind that in the immediate post-Tsumani period, there is an emergent need to curtail the spread of communicable diseases. Per Dr. David Nabarro of the World Health Organization, "There is certainly a chance we could have as many dying from communicable diseases as from the Tsunami.” Diseases like malaria, dengue fever and cholera have the potential to spread in the unsanitary conditions that prevail across all the effected areas.

What is obvious is that there is an urgent need for safe drinking water, sanitation equipment and supplies, oral rehydration kits, medicines and food. What is not so obvious, or perhaps not something the world would want to dwell over, are the long-term consequences of the Tsunami disaster. The current state of the effected populations; homelessness, poverty, malnutrition and communicable diseases are all the right ingredients to contribute to long term adverse physical and mental outcomes including the possibility of a bigger disaster in the form of creation of a colossal nidus for the spread of HIV and AIDS. When resources are scarce, marginalized and vulnerable populations may also suffer from a decline in social and human capitals, both of which have been shown to be associated with HIV/AIDS risk.3,4

We certainly do not want to sound as pessimistic as Malthus,5 but it also would not be wise to ignore the long-term impact of the Tsumani. So what are the questions we are left with? Where did we fall short? What can we learn from the unfortunate tragedy? And most important of all, how can we do better in the future? Finding detailed answers to these questions may take a long time. All we can say at this time is that there certainly was a lack of an effective early warning system, which could have prevented the loss of precious lives. The relevant agencies need to get their acts together to prevent such an occurrence in the future. In this day and age, we certainly should have the necessary tools to disseminate late-breaking, critically important information rapidly and efficiently to protect individuals and populations. More importantly, all possible resources need to be made available to the disaster-hit areas to prevent any further catastrophes, particularly preventable ones such as HIV/AIDS.


1. World Health Organization. Global infectious disease surveillance. World Health Organization Fact Sheet No 200. June 1998.

2. World Medical Association. Bull Med Ethics. 1994 Oct;No. 102:9-11.

3. Hasnain M, Mensah EK, Levy JA, Sinacore JM. Social Capital as a Predictor of HIV/AIDS Risk Behaviors. Presented at the XIV International AIDS Conference, Barcelona, Spain, July 2002.

4. Hasnain M, Levy JA, Sinacore JM, Mensah EK. Human Capital and HIV Risk in Injection Drug Users. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 2004.

5. Malthus TR. An Essay on the Principle of Population, as it Affects the Future Improvement of Society with Remarks on the Speculations of Mr. Godwin, M. Condorcet, and Other Writers. London, printed for J. Johnson, in St. Paul's Church Yard, 1798.

Competing interests: None declared

Competing interests: No competing interests

13 January 2005
Memoona Hasnain
Director of Research & Assistant Professor of Public Health in Family Medicine
Dept of Family Medicine, College of Medicine, Univ of Illinois at Chicago, Chicago IL 60612, USA