1

SN2B02 Disasters and Global Health

Challenges

Reducing the Health Impacts of Earthquake

GROUP MEMBERS:
16044474D KO KAI SUEN
16048328D LAM WING SHAN
16042618D LEE KA YU
16042602D LUI YING KWAN
16022252D LO SIN YU
16022413D SZETO WAI PONG
Content 2

1. Introduction
2. Health Impacts
a. Physical Injuries
b. Infectious Disease
3. Recommendations
a. Disaster Management Cycle
4. Conclusion
5. References
 3
Introduction
What is global health?

Global health is the worldwide improvement

of health, reduction of disparities, and
protection against global threats that
disregard national borders

(Macfarlane et al., 2008)

 4
Introduction
What is earthquake?

Due to the unusual movement of

crustal plate
Release huge amount of energy
Fault suddenly slip 1:30-1:43s

Earthquake

(U.S. Geological Survey, 2016)

 5
Introduction Why earthquake is a
global health issue?

Across national boundaries

International cooperation in
Rescue
Money support
Food supplies
Management
Provide/ maintain health
services
Post development
(Karkee, 2015)
 6
Earthquake
It needs our
attentions!

Obvious increasing trend

from 2010 to 2014

(Parsons & Geist, 2014)

Health Impact - Physical Injuries and Deaths 7
In past 30 years, an estimated 400,000 deaths and 1 million earthquake-related injuries

were reported.

The majority of injury and death in earthquake is trauma caused by collapse of buildings

Victims are unable to escape from the indoor area, such as at home or school.

(Doocy, Daniels, Packer, Dick & Kirsch, 2013)

Health Impact - Physical Injuries and Deaths 8
E.g., in China Yunnan earthquake 2014, hundreds of people died due to the

unreinforced masonry buildings and poorly constructed houses.

2016 Tainan earthquake, caused 115 indoor death in the collapsed building.

The falling building materials, such as concrete, unreinforced masonry, mud

and

stone walls increase the mortality risk.

(Doocy, Daniels, Packer, Dick & Kirsch, 2013)

Health Impact - Physical Injuries and Deaths 9

People usually suffer from different levels of physical injury and death due to

Direct
health
the collapse of buildings impact
Fractures, dislocation, wound infections, crush injuries and head trauma are

the most common types of injuries

Primar
In 2010 Haiti Earthquake, 222,570 people died and about 300,000 persons y
health
suffered from injuries.
impact
s

(Morbidity and Mortality Weekly Report,

2011)
Health Impact - Physical Injuries and Deaths10
Health Impact - Physical Injuries and Deaths11

Earthquake that happens in the resource-limited area

Large number of injuries, e.g.fractures, dislocation, wound infections

Injury-related medical procedures such as wound debridement, amputation, and orthopedic service were highly demanded

The needs for injury-related medical, surgical treatments and rehabilitation services could not meet the demand

Additional numbers of physical injuries result due to delayed treatment

(Morbidity and Mortality Weekly Report,

2011)
Health Impact - Physical Injuries and 12
Deaths
Health Impact - Physical Injuries and Deaths13

Other factors increase the number of physical injuries and deaths:

1. International humanitarian supports cannot delivered to the victims immediately after

the earthquake (Golden 72 hours of rescue)

2. Delayed emergency surgical and medical treatment affect the prognosis

3. Life-threatening wound infection and other health complications caused by improper

wound dressing

Golden
72
hours
Outbreak of Infectious Diseases 14
Definition

Infectious diseases are caused by pathogenic microorganisms, such as bacteria,

viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from
one person to another. - World Health Organization (2016)

Requires a period of time to be shown

Risk relatively low yet still common

In case of triggering tsunami

Higher risk of outbreak

(Murphy S., & Christian M.D., 2010)

Outbreak of Infectious Diseases 15

(contd)
Types

Water-related Vector-borne Others

Causes Contaminated water New habitat for vectors Pollution

sources

Disease Hepatitis A and E Malaria Coccidiomycosis

Acute watery Dengue fever
diarrhea
Example 2005 Pakistan 1991 post-earthquake 2005 Pakistan
Earthquake Costa Ricas Atlantic Earthquake
Region
(Watsons T. J. & et al., 2007)
Outbreak of Infectious Diseases 16

(contd)
Risk Factors Malnutrition
Host Inadequate vaccination
Host, Agent, Environment: In shortage of/delay in treatment

Interrelated
Virulence of pathogen strain
Distal, intermediate, proximate: Susceptibility to locally available
Agent drugs
Mutation/adaptability
In a causal relationship

Earthquake: Intermediate Overcrowding

Environment Violence
Poor Hygiene conditions

(Checchi, et.al., 2007)

Outbreak of Infectious Diseases 17

(contd)
Causes (Host Factor):
Malnutrition and dehydration

Difficult in access of food

Lack of nutrients

High susceptibility & severity of infectious diseases (Black R., 2003)

Immunity decreases (Fortes, M. B. & et al., 2012)

Outbreak of infectious diseases

Outbreak of Infectious Diseases 18

(contd)
Causes (Agent Factor):

Proliferation of pathogens and vectors

Rapid reproduction of germs and vectors

Collapse of trees (i.e. accumulation of organic substances) & damp

environment

Accumulation of waste and excreta

Encourage the growth of germs and fungi

(Murphy S., & Christian M.D., 2010)
Shortus M. et al. (2014)
Outbreak of Infectious Diseases 19

(contd)
Causes (Environment Factor):

Overcrowding shelter environment

Large scale of displacement

Poor hygiene

Enhances physical contacts between people

Occurrence of infectious diseases

(Noji E. K., 2005)

Checchi, et al (2007)
 20
Disaster Management Cycle

Aims:

(1) Reduce, or avoid, losses from

hazards;

(2) Assure prompt assistance to

victims;

(3) Achieve rapid and effective

recovery

(Warfield,n.d.)
 21
Recommendations Mitigation
Limitation: Narrowed and Single-disciplined
Study

Structural
Engineers

Ur
Planni ban
ng B o
ard

Rescue Team Earthquake

 22
Recommendations Mitigation
1. Frequent & Prompt Coordination between Professionals

Better preparation

Better design
Comprehensive
Dimensiona planning
l knowledge More effective
communications

Inter-discipline
cooperation
 23
Recommendations Mitigation
2. Improve Urban Planning by Local Government

Epicenter: Greatest damage when

urban area is close enough

Scattered pattern of construction should

be adopted

Avoid residential and commercial construction at

earthquake-prone areas if possible
 24
Recommendations Preparation
3. Improve Preliminary Planning for Disaster Relief by Local
Government
Aim: Remove similar (previous earthquake) barriers that might be repeated next time
 25
Recommendations Preparation
3. Improve Preliminary Planning for Disaster Relief by Local
Government
Zhang et al. (2012)

China Wenchuan Japan

Previous
Well prepared for
earthquake @
earthquake
1981

E.g.
- Structural
No improvement Standard
- Education
- Preparation
 26

Avoid crowded shelter

Site planning
ensure the most rational organization of space, shelters and facilities

3.5 m2 of shelter space per person

building one latrine for every 20 persons
locating the latrines at 30 m distance from shelters and at 100m distance
from water supplies
(Delmas &
Courvallet, 1994 )
Mitigation - Construct earthquake- 27
resistant buildings
Prevent building collapse in earthquake-prone regions

Reduce death and injuries caused by building collapse

Ensure earthquake-prone countries have strict guideline on the

earthquake-resistant construction

Two basic earthquake-resistant technologies:

Base isolation

Seismic dampers
Mitigation - Construct earthquake-resistant 28
buildings
1. base isolation
use of flexible material in the base of building
reduce seismic force
introduce flexibility to buildings
create resistance against lateral movement of buildings

(Subramani, Jothi, & Kavitha, 2014)

Mitigation - Construct earthquake-resistant 29
buildings
2. Seismic dampers
Special devices installed in buildings
Absorb energy provided by the ground motion to the building
Used together with base isolators
In order to enhance the seismic energy absorption

(Murty, 2005)
Mitigation- Construct earthquake-resistant 30
buildings
Limitations:
only limited on developed countries
have enough resource to follow the earthquake-resistant technology
limited in less developed countries
the earthquake-resistant technology is costly
specialized material should be used
specialized technicians and workers have to be hired in construction
base isolators are not applicable to all buildings
isolators are only applicable to low or medium rise building rested on hard soil
underneath

(Murty, 2005)
Mitigation- construct earthquake-resistant 31
buildings
Earthquake-resistant building suggestion for less
developed countries:
adobe can provide earthquake-resistant function only when
buildings are appropriately built
low cost, readily available
commonly used by rural people

(Blondet et al, 2011)

Mitigation- construct earthquake-resistant
32
buildings
Adobe construction recommendation to improve seismic
performance:

(Blondet et al, 2011)

Preparedness- public earthquake 33
preparation
promote public preparation on earthquake
especially in earthquake-prone countries
basic knowledge of survival skills for earthquakes
collect the essential survival items
e.g. food, water, torch, radio and medication
create an emergency plan for how to escape or survive in the earthquakes
learn first-aid skills
minimize the chance of getting physical injuries during earthquake
take the appropriate action to protect them from being injured

(Becker, Paton, Johnston, & Ronan,

2012)
 Planning how
34
Preparation- to respond

Activating public health event

Purpose:
response
Strengthening their immediate capacities to mitigate the impact
of the outbreak
Preventing epidemics and the spread of disease

Procedure:
- Involve the educational content into school syllabus
(Lack of knowledge Low detection rates)

e.g. Transmission method of different infectious diseases

How to protect themselves from infectious diseases
 35
Preparation-
Activating public health event response
- Increase awareness of public health
e.g. Holding information booth regularly
e.g. TV program about preventing
infectious disease
 36
Preparation-improve health care
system
Training for coping strategies with earthquake
Improved detection and response (e.g. having a plan for emergency
action)
Daily health assessment if abnormal findings isolation
(WHO, 2006)
Involve a Reporting system
Early detection of case report when earthquake occurred
Immediately identify the nature & location of a particular
disease outbreak, the characteristics of clusters of cases
(Wang, et.al., 2008)

Provided medical equipment and supplies to the health post

from INGO
 37
Response - Infectious disease
Efforts to minimize the hazards created by a disaster
Immediate
Clean water interventio
n

Proper Hand
hygiene
-Emergency toilet
-Prevent crowded
shelter
 38
Christchurch Twin No-Mix Emergency
Toilet
The lid will help keep the smell in and insects out
(If a fly gets on the feces and then lands on your food illness)
Prevent fecal-oral transmitted diseases

Preparation:
Prepared by the government
before earthquake occurred
educate how to use the toilet

Response:
Distribute by government until proper
toilet have been built
 39
Clean Water
Normally
INGO distribute distilled water

Problem:
Limited resources

Water source from river

 40
Emergency Water Purification
P&G water disinfectant powder

Reduction of bacteria, viruses, and protozoa reduce diarrheal disease

Increased free chlorine protection against contamination
(Centers for Disease Control and
Prevention,2014)

Limitation:

too many procedures

Government finishing the
procedure first then transport the
clean water to affected area.
 41
Proper hand hygiene

Provide hand rubs disinfectants to affected area

Preparation:
-Education
e.g Hand hygiene
Preparation of food (enough heating)
Storage of food (safe temperature)
 42
Distribute packaged food
Reduce the chance of
being contaminated

Easy preparation

Easy storages
 43
Recovery-Building back better

Increase number of medical clinic in rural area

can provide health assessments/ health services to victims
continuously
health promotion
overall increase citizens health status in a long term way

reduce infectious cases after earthquake

happened through education
reduce chance for diseases to transmit
 Preparation- Vaccination 44
Vaccination: important infection control method, cost-effective

Provide vaccination in pre-earthquake

UNICEF supports vaccination programmes in 100 countries

To target unimmunized children

Increase vaccination coverage among children

Provide for both the cost and delivery of vaccines

Provide measles vaccine, oral cholera vaccine

Since 2000, UNICEF and its partner has supported the vaccination
of 500 million children in the worlds poorest countries

Saving an estimated 7 million lives

(Unicef, 2011)
 45
Preparation - Vaccination
Limitations of the UNICEF vaccination programme:

For less developed countries:

Limited resources to promote vaccination
only cover a few infectious diseases appears after earthquake
E.g. Measles, cholera
Unlike developed countries: government have their own vaccination
programme, provide full protection on infectious diseases

Only children can receive vaccination

Neglect other weak immunity group
e.g. elderly

(Unicef, 2011)
 46
Mitigation - Vaccination

Implement rapid mass vaccination in post earthquake

Prevent vaccine-preventable diseases

e.g. measles, hepatitis A and E

Targeted all of the people residing in the temporary camps, regardless

of their vaccination histories

Especially for children under 15 years old without vaccination

(Rainey et al., 2013)

 Mitigation - Vaccination 47

Limitation of mass vaccination in post earthquake (according to

WHO experience in Haiti earthquake 2010):
hardlyImprovement:
ensure everyone receive vaccination
WHO reported
Better site planning
some reasonsof
forthe
notvaccination campaign
being vaccinated during the campaign
unaware
Increase ofpeoples awareness of vaccination campaign
the campaign
Inform
not in thevictims
camp atof the
the time
vaccination campaign, ask them to
of vaccination
wait for
highly vaccination
mobile population in temporary camp
limited information on the location of the target population

(Rainey et al., 2013)

References 48
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Becker, J., Paton, S., Johnston, D., & Ronan, D. (2012). A model of household preparedness for earthquakes: How individuals make meaning of
earthquake information and how this influences preparedness. Natural Hazards, 64(1), 107-137.

Blondet, M., Medina, G. V., Brzev, S., & Rubios, . (2011). Earthquake-Resistant Construction of Adobe Buildings: A Tutorial. Retrieved from
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Centers for Disease Control and Prevention. (2014). Flocculant/Disinfectant Powder. Retrieved from http://www.cdc.gov/safewater/flocculant-
filtration.html.

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References 49
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References 50

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