A mother and child heading for a place, through 'nosedeep' flood water in Birshing village, south west of Guwahati,

on July 14.

Top 10 most important disaster by number of killed in 2007

Event
Cyclone Sidar, November Flood, July August Flood, July"Se#tember Flood, August +eat ,ave, July Flood, June July -arth1ua.e, August Cyclone 3emyin, June Flood and 4andslides, June Flood, July

Country
Bangladesh Bangladesh $ndia %orea &em' (' )e# South -uro#e and the Bal.ans China (' )e#' (eru (a.isthan (a.isthan $ndia

People Killed
4234 ! !3 * ! /*0 /3/ / 2 242 225 22/ 6otal 2303

Source:Annual Disaster Statistical review,CRED,Belgium

Impact
Two illion people !ace "ealt" t"reats ecause t"ey are at ris# o! or e$posed to crisis condition Twenty million people or %& countries are actually in crisis Si$ty 'ive percentage ()%*+ o! Epidemic reported worldwide occur in comple$ Emergencies,

Impact: A Larger Picture

&irect losses
-uman lives .ivestoc#, ot"er animals Private property /unicipal in!rastructure Power0 telecommunications in!rastructure -ealt"0 education assets

$ndirect losses
E$port0 import Agricultural output :ndustry0 services output Remittance income 'all in earning potential (due to disa ility, trauma etc,+ 4nemployment -ealt" "a;ards

6ertiary losses
.ong<term development =verall investment climate 'unds reallocation Community migration0 relocation

1u2arat eart"3ua#e estimate: 4S5 6789 /illion

1u2arat eart"3ua#e estimate: 4S5 )6% /illion

1u2arat eart"3ua#e estimate: 4S5 >&9? /illion

Mortality due to natural a!ards in India

Name o7 &eaths caused by natural Country disasters Natural disasters mortality ratio 8#er !!,!!! deaths9
7997< 799% 799)< >&&& >&&7< >&&% >&&)

:ndia

7997< 799%

799)< >&&&

>&&7< >&&%

>&&)

>&,?>?

>8,)&%

@887@

)98

@?

)6

7&6

Source: ESCAP Statistical Aear oo# !or Asia and t"e Paci!ic >&&?: "ttp:00www,unescap,org0stat0data0sy >&&?0

"amaged caused by Mass casualty #$ents due to %atural "isasters in India

Aear People a!!ected ( .a#"+ %>7,? %&7,? %9@,6@ ?88,79 -ouses B uildings, partially or totally damaged 7%)6@&% 67&@&)@ >?6)6%% 8@)8?8 Amount o! property damage0los s (Rs Crore+ &,?> 7&>&,9? 8&&,&& 7>&&&

7998 7999 >&&& >&&7

List of %atural "isasters (Recent Past)

&isaster Cyclone, 799?, 7999 'lood, >&&&, >&&@, >&&%,>&&?,>&&8 Eart"3ua#e, 799?C 7999C >&&7C>&&@C >&&% .andslide, >&&@ Tsunami, >&&@ -eat Dave, >&&@ (lace 1u2arat, =rissa AssamC Bi"arC DBC 1u2aratC =rissaC 4ttaranc"alC Tamil EaduC /a"aras"tra /a"aras"traC /PC 4PC 1u2aratC Andaman B Eico arC FBK Kas"mirC S"imla, Eort"east region Sout" :ndia Del"i, -aryana, 4P, Pun2a

&ealt Issues after a "isaster

A##ro#riate handling o7 the dead $n:ury and disability (sychosocial #roblems ;ater and -nvironmental sanitation Communicable &isease )e#roductive and child health issues Sustaining .ey health care delivery 7unctions, including medicines and critical medical su##lies $mmuni<ation Coordination

#n$ironment &ealt Management

During Emergencies

#ffects of "isaster on 'eneral #n$ironment ( )anitation

Contamination o! drin#ing water Contamination o! !ood .oss o! general immunity Breeding and increased density o! insects and rodents, Breeding o! vectors Spread o! water orne diseases i,e, c"olera, enteric !ever Spread o! vector orne diseases i,e, malaria, dengue Spread o! uncommon ;oonotic diseases due to ecological distur ances i,e, plague, leptospirosis,

Priority #n$ironmental &ealt )er$ices

Ade3uate amount o! sa!e drin#ing water Disposal o! "uman e$creta Disposal o! waste water and solid waste Ade3uate s"elter 'ood protection measures Gector control measures Promoting personal "ygiene and :EC Disposal o! dead odies

#n$ironmental &ealt and Priorities for inter$ention in Emergencies

To recognise

To understand To understand

To design To descri e To identi!y

t"e environmental "ealt" ris# !actors and constraints o! environmental "ealt" management, t"e asis !unction o! a sanitation programme t"e value o! various water sources and minimum standards !or water 3uality and 3uantity a simple environmental "ealt" programme diarr"oeal out rea# control strategies #ey indicators !or monitoring environmental "ealt" programmes,

Problems identified after t e rapid en$ironmental need assessment in Tsunami affected areas

Inadequate H.P. Water quality/availability Irregular tank filling #olid "aste dis$osal. %ly & osquito nuisance %ish "aste 'ry fish sell

Lack of Ventilation Inadequate Bathroo !vercro"ding

'efecation near the shelters. Inadequate sanitary facilities

Water stagnation Blockage of drains

Poor use/

aintenance

4se .ocally availa le trained manpower as Environmental -ealt" Specialist are not always availa le, Restore Pre<disaster service on priority,

)afe "rinking *ater )upply

"iseases related to drinking +ater contaminated +it micro,organisms

Diarr"oeaH Typ"oidH -epatitisH C"oleraH

( Contaminated water is not the only cause of these diseases water !uantity, poor sanitation and poor hygiene practices also play a role

'eneral Principles of #mergency *ater Management

All People s"ould "ave access to su!!icient 3uantity o! water !or drin#ing, coo#ing and personal and domestic "ygiene, At least 7% liters o! water per person per day need to e collected T"ere is at least 7 water point per >%& people 'low at eac" water collection point is at least &,7>% liters per second T"e ma$imum distance !rom any s"elter to t"e nearest water point is %&& meters,

'eneral Principles of #mergency *ater Management cont

Ensure 3uality o! water to reduce t"e transmission o! disease Evaluate pota ility o! potential water sources y rapid survey Assess t"e iological ris#s associated wit" water Determine t"e pattern o! sur!ace drainage, pro$imity to local sewage system and potential !or c"emical contamination Rapidity to convert a source into sa!e one is very important Rapid environmental "ealt" remedies: repair o! sewage lines0parapet o! a well :! no local sources availa le, resort to water distri ution system

. ecklist for *AT#/ )A0#T1 measures at 0ield le$el

Dater !or drin#ing need to e collected !rom t"e cleanest possi le source :! necessary, a distinction is made etween water !or drin#ing and water !or ot"er uses, suc" as at"ing, laundry, watering animals, Dater sources need to e protected !rom !aecal contamination y !encing (to #eep animals away+, and y sitting latrines or de!ecation !ields at least 7& I away, depending on ground conditions,

At t"e source

. ecklist for *AT#/ )A0#T1 measures at 0ield le$el

Dater is collected and stored in clean, covered containers, Dater is ta#en !rom t"e storage container wit" a clean, long<"andled dipper or t"roug" a tap placed slig"tly a ove t"e ottom container, E!!orts are made not to waste water, :! t"ere is a ris# t"at water is not sa!e, it is !iltered and0or c"lorinated or oiled Dater !or ma#ing !ood or drin#s !or young c"ildren is oiled

Collection, storage and use o7 ,ater at household level

=se o7 ,ater

Met ods of making "rinking +ater )afe

Straining> :ncase "eavy sediment or !loating matter present water

must e strained t"roug" several layers o! clean clot"es e!ore !urt"er processing+

&isin7ection>

Solar &isin7ection> &isin7ection by Boiling > Boiling vigorously !or 7& minutes
ma#es water sa!e !rom "arm!ul acterial contamination ut it is very di!!icult to searc" !uel !or oiling immediately a!ter a disaster

&isin7ection using Chlorine > C"lorination, t"e most common

met"od in emergency

Disinfection should not be used as a substitute for protecting water sources from contamination.

"omestic . lorination of "rinking *ater

Crus" commercially availa le c"lorine<releasing ta let Put in t"e water container wit" >& litres o! water Allow to stand !or 6& minutes 4se water wit"in >@ "ours

Containers with a narrow mouth are recommended for the storage of drinking water

. lorination . ecklist

T"e optimum c"lorine residual in a small, communal water supply is in t"e range o! &,6 to &,% mg0l C"lorine needs at least "al! an "our contact time wit" water to disin!ect it Eever add any solid !orm o! c"lorine directly to a water supply, as it will not mi$ and dissolve, Always ma#e up as a paste !irst, mi$ing t"e c"lorine compound wit" a little water Disin!ection is only one de!ense against disease, Every e!!ort s"ould e made to protect water sources !rom contamination, and to prevent su se3uent contamination during collection and storage T"e c"lorine dose re3uired to disin!ect a supply will increase i! t"e water is very tur id, :n suc" circumstances, it is est to treat t"e water to reduce tur idity e!ore c"lorination

Pro$ision of )afe *ater )upply

Drin#ing water sac"ets may

provided during initial p"aseC later water may e provided y water tan#ers
Temporary small water tan#s

may e provided in t"e camps

Ade3uate c"lorination o! water

ensured y t"e "ealt" wor#ers

Dater Juality /onitoring done

y testing !or residual c"lorine and micro iological testing o! samples

T ree .ommon Tests

'ield < ->S Test .a < /ultiple < Tu e 'ermentation Test (/PE met"od !or coli!orm acteria+ =T Test

Monitoring

.ocation o! stand postKover"ead tan#s /et"od o! testingKp"ysical, c"emical and acteriological c"aracteristics Periodicity o! testing ResultsKc"lorine level Distri ution area /ode o! distri utionK=-T, =-T and pipes, lorries, R= system JualityKdate o! testing KTDS KBacteriological content Remedial actionKc"lorination D"et"er end<point c"lorination testedL =t"ersKstorage, "andling at "ouse"old level

)afe "isposal of &uman #2creta

A . ecklists for Action at 0ield Le$el

#3./#TA "I)P4)AL

Actions ta.en
De!ecation is avoided near water sources and water<treatment plants, up"ills o! camps and water sources, in !ields destined !or crops, along pu lic roads, near communal uildings suc" as clinics, near !ood<storage !acilities, De!ecation is done in latrines, trenc"es, de!ecation !ields, etc, People avoid going are!oot to de!ecate, C"ildren do not visit a de!ecation area alone, Eew arrivals at emergency settlements are aware o! t"e arrangements !or t"e de!ecation and t"e importance o! complying wit" t"em,

4se o! designated places !or de!ecation

A . ecklists for Action at 0ield Le$el

#3./#TA "I)P4)AL (contd.)
Actions ta.en

C"ildrenMs sanitation

4ncontrolled de!ecation y c"ildren is stopped, (T"e !eces o! young c"ildren are more "arm!ul t"an t"ose o! adults+ T"e stools o! young c"ildren or a ies are wrapped in leaves or paper and uried or put in a latrine, Aoung c"ildren are "elped to de!ecate into an easily<cleaned container t"at can e emptied into a toilet and was" out, C"ildren are cleaned promptly a!ter de!ecation and "ave t"eir "ands was"ed, People w"o clean c"ildren was" t"eir own "ands t"oroug"ly a!terwards,

)ome Tips for safe )anitation issues "uring "isaster

Sanitation Temporary latrines s"ould e constructed .ime to e used in communal trenc"es Area to e #ept clean Daste water !rom t"e area to e properly drained out Sa7e distance o7 4atrines ) metres !rom dwellings 6& metres !rom community well S"ould not e located at "ig"er level t"an drin#ing water source S"ould not touc" t"e water ta le

)anitary Toilets

Development o! t"ree designs o! t"e community level toilets and inculcate t"e "a it o! using t"em :ncineratorKa way to promote toilet "a its among women and disposal o! sanitary nap#ins, Development o! a y<!riendly toilets

)trategies to .ontrol &uman #2creta "isposal at "isaster sites

Designate speci!ic areas !or de!ecation Protect latrines !rom sur!ace water drainage Consider cultural !actors in latrine design (e,g,, need !or privacy+ Educate t"e population Ensure proper latrine maintenance 'acilitate t"e population)s access to latrines -and Das"ing wit" soap

Maintaining a )anitation )ystem for &uman #2creta

Populations are unli#ely to use latrines o! t"ese are not #ept clean /ay re3uire contracting out * t"e cleanliness service Regular addition o! soil, diesel or as" to t"e latrines Ade3uate source o! lig"ting !or nig"t use Proper ad2ustment in si;e to !acilitate t"e use y c"ildren Periodic inspection y "ealt" aut"orities is essential Relie! agencies0E1=s may provide tec"nical assistance in t"e !orm o! sanitarians !or construction, maintenance B !or supply o! dis<in!ection materials

Personal &ygiene and I#.

A . ecklists for Action at 0ield Le$el

PERSONAL HYGIENE
Actions ta.en Dater !or was"ing

:! possi le, plenty o! water is used !or was"ing, Clot"ing is laundered regularly, T"e most readily availa le water is used !or personal and domestic "ygiene,

A . ecklists for Action at 0ield Le$el

PERSONAL HYGIENE
Actions ta.en -and< was"ing

All !amily mem ers was" t"eir "ands regularly: a!ter de!ecatingC a!ter cleaning a c"ild w"o "as de!ecated and disposing o! t"e stoolC e!ore preparing !oodC e!ore eatingC e!ore !eeding a c"ild, Adults or older c"ildren was" t"e "ands o! young c"ildren,

)ome Tips .oncerning Personal &ygiene "uring "isaster

(ersonal +ygiene

-and was"ing, cleaning and at"ing !acilities Ade3uate water supply Avoid overcrowding in sleeping area .aunc" education campaign on personal "ygiene

Information5 #ducation and .ommunication

Based on t"e rapid environmental assessment, target<speci!ic :EC Activities on environmental "ealt" need to e initiated in t"e disaster a!!ected locality wit" t"e "elp o! community volunteers, government wor#ers and E1=s wor#ing in t"e area, T"e :EC activities s"ould include Personal "ygiene Sa!e and w"olesome water supply Dastewater disposal E$creta disposal Gector control

Information5 #ducation and .ommunication cont

As in sanitation, local pro!essionals are t"e people w"o are est suited to develop and deliver "ygiene education Educational messages s"ould e s"ort and !ocused, T"e s"ould also !ocus on e"aviors t"at are not eing practiced y a signi!icant !raction o! t"e population,

)olid *aste and *aste *ater "isposal

A . ecklists for Action at 0ield Le$el on )olid +aste "I)P4)AL

Actions ta.en

Re!use is not to e scattered a out,

(T"is

Solid Daste

encourages insect reeding and attracts rats w"ic" can e a nuisance and transmit disease+, :n t"e immediate post<disaster period, i! organi;ed re!use collection "as not een set up, "ouse"old solid waste is uried y !amilies, =nce collection arrangements "ave een made, re!use is placed in t"e ins provided, 'illed ins are not le!t in !ood<preparation areas, Bins are #ept securely covered to prevent scavenging y c"ildren or animals, /anure !rom livestoc# is collected and disposed o! as sa!ely,

A . ecklists for Action at 0ield Le$el on )olid +aste "I)P4)AL

Solid ,aste management

Sanitary disposal o! re!use to control vector< orne diseases Burying or urning is recommended Carcasses waiting urial s"ould e sprin#led wit" #erosene

)olid *aste Management

A continuous "ealt" education programme need to e conducted on solid waste management and t"e importance o! vector control, D"erever necessary, t"e stagnated solid waste needs to e removed wit" t"e "elp o! local E1=s, community volunteers and sanitary wor#ers, A system in coordination wit" t"e "ealt" aut"ority, sanitary wor#ers, E1=s and community volunteers to maintain solid wastage disposal y collection, segregation and transportation !rom t"e s"elter areas, need to e developed,

*ater "isposal
Li6uid *aste

A . ecklists for Action at 0ield Le$el on WASTE DISPOSAL

Actions ta.en

Disposal
.i3uid Daste

Standing pools o! polluted wastewater (!rom was"ing, !ood preparation, wasted tap water+ are not to e allowed to !orm, (T"ey encourage mos3uito reeding, w"ic" is a "ealt" "a;ard+, C"ildren need to e prevented !rom playing in or near "a;ardous pools o! water, Arrangements !or disposing o! li3uid waste, suc" as using soa#age pits, are understood and !ollowed,

*aste+ater Management

Community mo ili;ation and education y sanitarians t"roug" demonstrations o! water disposal systems, :n s"elters and villages, t"e drainage system need to e improved scienti!ically in colla oration wit" t"e local E1=s and government aut"orities Eo stagnation o! waste water Eo water accumulation around "andpumps,wells or standpoints,

7ector .ontrol

A . ecklists for Action at 0ield Le$el

VECTOR CONTROL
Personal protection against disease vectors Actions ta.en -ouse"old re!use is removed regularly to avoid uild<up o! "ouse!lies and rat in!estations, 'oodstu!!s are #ept in rodent<proo! stores or containers, Coo#ed !oods, w"ic" may "ave een contaminated y "ouse!lies, are properly re"eated to a oil, Clot"es are laundered !re3uently and insecticidal s"ampoos are used to prevent lice, :n areas w"ere mos3uitoes are a pro lem, ed nets or edroom screen are used, i! availa le,

)ome Tips .oncerning Management for 7arious #& Issues "uring "isaster
?ector Control

Resume collection and sanitary disposal o! waste Conduct pu lic education campaign Survey potential mos3uito, rodent and ot"er vector reeding sites Eliminate vector reeding sites Resume indoor and outdoor spraying Store !ood in enclosed and protected area Keep watc" on environmental sanitation and personal "ygiene

7ector .ontrol

Breeding places identi!ied and control measures Training programme organi;ed !or t"e local community and E1=s !or vector control in t"e s"elters, Training t"roug" demonstration in t"eir dwelling places would motivate t"e community to aim !or !ly<!ree and mos3uito<!ree s"elters, Activities suc" as application o! c"emicals, spraying, oil alls, sand !illing and levelling activities wit" community participation

7ector control measures

N N N N N

'ogging :nsecticide spray Anti<larval /os3uito nets :nsect repellants

#stablis .ommunicable "isease )ur$eillance

/ost important to get relia le in!ormation, avoid rumours Relia le in!ormation reassures pu lic a out t"e disease incidence, Surveillance to e led y one agency S"ould e lin#ed wit" response mec"anism Availa ility o! consensus national tec"nical guidelines

) elter

/elief camp
NCamp cleanliness N'ood availa ility NDater and Toilets provided

.onsiderations for setting up ) elters

.ocation: close to road, drainage good /aintain !amily0clan identity Special consideration to t"e needs o! elderly B disa led /onitor y Pu lic -ealt" Surveillance Determine t"e source o! sa!e waters Ensure sa!e disposal o! "uman e$creta /inimi;e overcrowding Proper drainage system

P ysical Issues Associated +it ) elter Management

Provision o! roo! I plastic s"ed Tents0Pre<!a ricated "ousing units %& metre<wide !ire reac" recommended !or every 6&& metre o! temporary s"edding 1round s"eets0 lan#ets0source o! "eating or cooling

A . ecklists for Action at 0ield Le$el

SHELTER
Actions ta.en At t"e disaster site

D"ere people are trying to "ouse t"emselves in t"e ruins o! t"eir previous "omes, t"ey ta#e steps to avoid ris#s !rom t"e lac# o! structural integrity o! t"eir uildings, :! t"eir "omes are de!initely unsa!e, people move,

A . ecklists for Action at 0ield Le$el

SHELTER
Actions ta.en :n longer< term emergency settlements

People ta#e part in residentsM committees to voice t"eir views a out t"e setting up and running o! a camp, Residents participate in cleaning t"e settlement, C"ildren do not enter dangerous areas o! t"e settlement and, i! necessary, volunteers guard unsa!e areas,

0ood )afety

)ome Tips .oncerning Management for 7arious #& Issues "uring "isaster
Food Sa7ety

Kitc"en sanitation I most important 4tensils cleaned daily Personal "ygiene maintained 'ood storage I precautions against rodents and insects

/ules for )afe 0ood Preparation

Coo# raw !oods t"oroug"ly Eat coo#ed !oods immediately Store coo#ed !oods care!ully Re"eat coo#ed !oods t"oroug"ly As !ar as possi le provide "ot !ood, Avoid contact etween raw !oods and coo#ed !oods C"oose !oods processed !or sa!ety Das" "ands repeatedly Keep all #itc"en sur!ace clean 4se sa!e water

"o you prepare food safety8

Coo#ing #ills germs

T"oroug"ly coo# all meats, !is", and vegeta les Eat t"em w"ile t"ey are "ot

Das"ing protects !rom water< orne diseases

Das" your "ands e!ore preparing or serving !ood Das" your dis"es and utensils wit" soap and water

Peeling protects

Eat only !ruits t"at "ave een !res"ly peeled, suc" as oranges and ananas

Keep it clean I coo# it, peel it, or leave it

Disposal of Dead Bodies in Emergencies

Mortuary Services

:t is important to provide secure mortuary !acilities i! urial or cremation are li#ely to e delayed, A temporary mortuary site s"ould consist o! a reception, a viewing room, a storage c"am er !or odies not suita le !or viewing and a room to store personal possessions and records, Bodies s"ould e stored at @&C, alt"oug" t"is is rarely possi le, /ortuary sta!! s"ould wear gloves and protective clot"ing and s"ould was" wit" disin!ectant soap, T"e minimum !acilities are stretc"ers, leat"er gloves, ru er gloves, overalls, oots, caps, soap, disin!ectants and cotton clot", To close a temporary mortuary, appropriate cleansing o! t"e site s"ould ta#e place,

Body Disposal

Burials in common graves and mass cremation are rarely warranted and s"ould e avoided, Burial is t"e pre!erred met"od o! ody disposal in emergency situations unless t"ere are cultural and religious o servances w"ic" pro"i it it T"e location o! graveyards s"ould e agreed wit" t"e community and attention s"ould e given to ground conditions, An areas o! at least 7%&& m> 0 7&&&& population is re3uired, T"e urial site can e divided to accommodate di!!erent religious groups i! necessary Burial dept" s"ould e at least 7,% m a ove t"e groundwater ta le, wit" at least a 7 m covering o! soil, Burial in individual graves is pre!erred, Burial procedures s"ould e consistent wit" t"e usual practices o! t"e community concerned,

Publications

Re!erence: "ttp:00www,w"oindia,org0EE0Section660Section6@O7)@),"tm

T-AEKS