Public health impact of disasters
Introduction associated with the impact of earthquakes
Each year millions of people are affected By Kimberley I. Shoaf, DrPH & Steven J. on human health, a key factor associated
by natural and manmade disasters around Rottman, MD, FACEP, UCLA Center for
with fatal injuries in earthquakes is
the world. 1999 was an example of the building collapse.
Public Health and Disaster Relief
devastation that natural hazards can have Earthquakes in which a large number
on humanity. Tornados, hurricanes, heavy of buildings collapse result in many more
rains, and earthquakes resulted in tens of deaths than those where there is minimal
thousands of deaths and many more relationships are not linear, however. For collapse. Building collapse is correlated
affected. Close to a million people have example, not all earthquakes result in with the magnitude of the event, its
found themselves homeless, economically large numbers of injuries or deaths and proximity to the building, soil conditions,
impacted, or injured because of these hurricanes can, in fact, result in large and the construction practices utilized
disasters. Indeed, disasters would not be numbers of fatalities. (Bourque 1998). The combination of a
disastrous if it were not for their effect Tropical storms and hurricanes large earthquake, in close proximity to a
on the human population. While disasters The number of fatalities associated with population center, built upon soft soil,
cause problems that exact a human toll hurricanes in the western hemisphere using construction practices which do not
and are amenable to public health inter- have decreased dramatically with the employ anti-seismic reinforcements, can
ventions, the application of public health advent of improved storm tracking and result in unimaginably large number of
principles to disaster management has the issuance of hurricane warnings. fatalities.
been minimal. This paper explores the Hurricane Mitch, however, provided a The 1999 earthquake in Turkey is an
public health effects of natural disasters stark reminder that hurricanes remain a example of the potential that earthquakes
and some of the public health principles significant threat to life in that region of have for death and destruction. A magni-
which can be applied to disaster manage- the globe. In October 1998, Hurricane tude 7.4 earthquake occurred on the North
ment. Mitch devastated Central America. Even Anatolian Fault, near the town of Gölcük
The impact of natural hazards on the though the hurricane had been tracked, on August 17, 1999. Hundreds of apartment
publics health can be divided into four warnings were not issued to the popu- buildings, constructed out of reinforced
categories: lation (Corrales 1999). In Honduras alone, concrete collapsed on their sleeping
direct impact on the health of the 8000 people were killed as a result of occupants. The results were an estimated
population flooding and landslides. The pattern of 17,000 deaths with an additional 10,000
direct impact on the health care system the injuries and deaths associated with people missing and presumed dead.
indirect effects on the populations Hurricane Mitch was also different from Another 24,000 individuals were treated
health other hurricanes. Generally hurricane- for injuries (MMWR1999). An earthquake
indirect effects on the health care related mortality has principally been of similar magnitude occurred a month
system. associated with drowning from storm later in Taiwan. The 7.6 Mw earthquake
surges (Noji 1997). But a large number of also struck in the middle of the night killing
Direct impact on the health of a
the Hurricane Mitch fatalities were approximately 2400 people. While as many
population
associated with inland flooding and as 5000 buildings reportedly collapsed in
The most obvious impact on the health
mudflows resulting from 5 days of Taiwan, many of them were non-engi-
of a population affected by a disaster is
torrential storms leaving behind 30 inches neered low-rise buildings as compared to
that of injuries and deaths that can be
of rain (PAHO 1999). The sustained high the reinforced concrete buildings in
attributed directly to the disaster. Each
winds associated with these storms also Turkey which were more deadly (Goltz
year, approximately 300 natural disasters
have the potential of causing blunt trauma 1999).
occur worldwide, exacting a human toll
from flying debris as well as from Even a relatively small earthquake can
of approximately 250,000 lives. In the past
structural collapse of buildings. Several have devastating effects. On January 25,
20 years, natural disasters have claimed
deaths in Hurricane Andrew in South 1999 a magnitude 5.9 earthquake occur-
the lives of close to 3 milliion people and
Florida in 1992 were attributed to the high red in the coffee growing region of
have negatively affected the lives of at least
winds associated with that storm (Noji Colombia. The relatively moderate
800 million more (Noji 1997).
1997). earthquake however struck an area that
Injuries had soil conditions which exacerbated the
Different types of disasters result in Earthquakes shaking experienced in the city of
different patterns of injury and these, in Injuries and the resulting fatalities Armenia. The construction practices
turn, produce variable levels of morbidity associated with earthquakes vary tremen- prevalent in building in the region did
and mortality. Generally it is believed that dously from one event to the next. Both not include any codes for anti-seismic
earthquakes and rapid flooding (i.e. the number and severity of injuries are reinforcement until 1986. As a result of
tsunamis and flash floods) are capable of related to a number of factors including the earthquake, hundreds of reinforced
producing large numbers of deaths. the magnitude of the earthquake, its concrete buildings collapsed, killing
Earthquakes and high wind events (such proximity to a populated area, the soil type, nearly one out of every 250 people in this
as tornados) are capable of producing building construction, time of day and community of 250,000 (Shoaf 2000).
large numbers of severe injuries requiring population characteristics and behaviors. The force of the earthquake is not the
intensive care (Noji 1997). These While there are a large number of factors only cause of death. Secondary hazards
58 Australian Journal of Emergency Management
, such as firestorms and tsunamis can also typhoid would occur as a result of the smaller the ability to provide vector
wreak havoc and a high death toll. It is large number of dead bodies. While there control in the region was greater. Sur-
estimated that as many as 10% of the are sporadic cases of typhoid in Turkey it veillance in Colombia demonstrated that
deaths in the Kobe earthquake were a is not a disease that is common there. One there was no increase in either classic or
result of the fires that ignited from individual was treated for typhoid by hemorrhagic dengue fever. Surveillance
ruptured gas lines. Rubble in the narrow emergency medical personnel following in Honduras however, demonstrated a
streets restricted the fire departments the earthquake, although the case was not Bimodal increase in cases of dengue: a
access to the fire, allowing it to spread confirmed as typhoid and the source of small increase immediately following the
across large sections of the city. contagion was not identified. A single case hurricane and a second increase in
In 1998 a magnitude 7.0 earthquake of typhoid in an area where sporadic cases January, 1999. The destruction of the
struck off the coast of Papua New Guinea. exist is not an outbreak. However, that case transportation and health care sectors
While the quake was felt, it did no damage fueled a great deal of commotion in the from massive flooding made it more
to the small houses in the villages off the media and the public health community. difficult for the health care sector to
coast. However, 15 minutes later three Dr. Claude deVille de Goyet of the Pan- respond to a disaster of such magnitude.
tsunamis struck the coastal villages. It is American Health Organization wrote an While Colombias public health infra-
estimated that as many as 3000 of the 8000 op-ed piece for the New York Times, structure was most likely a contributing
inhabitants of the region died as a result which unfortunately was not carried. In factor in the absence of post-earthquake
of the waves, which exceeded 12 meters that piece, Dr. de Goyet talked about the disease outbreaks, a disaster may increase
(USC 1998). Many of these deaths were a myth that disasters result in epidemics of the demands on an already weak public
result of the force of such a large amount infectious diseases and emphasized health infrastructure in developing
of water surging against the body. For instead the need for maintenance and countries. This may result in a shift in
those who survived the force, many quick restoration of sanitary services and priorities away from building com-
drowned, as they were unable to swim. potable water to the affected population, municable disease prevention and control
Non-fatal injuries also vary in severity as well as surveillance of its health status. programs in non-disaster times, to more
and number and are dependent on a Dr. de Goyet also admonished post-diaster urgent efforts to respond to a legitimate
number of variables. Unlike fatalities the efforts aimed both at the quick disposal increase in cases when a disaster occurs
critical factor is not necessarily building of bodies as a public health measure, as (Richman 1993).
collapse or even damage to structures. well as large immunisation campaigns No outbreaks of infectious disease,
Non-fatal injuries can range from very geared to counter epidemics of specific such as dengue, have been reported
minor injuries such as lacerations and infectious diseases that simply do not following similar disasters in the United
injuries to soft tissue to such life- occur following these incidents. States or other developed countries. This
threatening injuries as trauma to internal A more accurate reflection of how well is simply because infectious diseases do
organs. Whereas fatal injuries are usually a community can withstand the adverse not represent major causes of illness or
caused by building damage, these non- health effects caused by a disaster may be death in the United States. While dengue
fatal injuries appear to be more directly found in the strength of the public health fever is a possibility in parts of the United
associated with ground shaking. The system in place prior to the disaster. States, particularly southern Florida,
Northridge earthquake of 1994 provides Consider the occurrence of dengue fever because the occurrence rate is small, any
an example of this. Whereas a majority of following both Hurricane Mitch in outbreak detected by surveillance would
deaths occurred in collapsed buildings, Honduras and the earthquake in Colom- most likely also be small and not expected
most non-fatal injuries (both those who bia. be a large additional burden on a public
were hospitalised and those who sought Honduras has a public health system health system that is trying to provide
treatment elsewhere) were more asso- which is making great strides in im- basic necessities in response to a disaster.
ciated with non-structural responses to proving the health situation for its
ground shaking. The two major causes of population. In the last 10 years, both Acute illnesses
non-fatal injuries were being struck by maternal mortality and infant mortality In contrast to infectious diseases, disas-
objects (or running into them) and falls have decreased steadily in Honduras. ters do have the potential for other types
(Peek-Asa et al. 1998, Shoaf et al. 1998). However, infectious diseases continue to of short-term impact on the populations
be the principal reason for medical care health. Some disasters have the potential
Communicable diseases and hospital admission and represent six for directly or indirectly causing acute
Many believe that the primary role of of the top ten causes of death in the illnesses in an exposed population.
public health in disasters is to control country (PAHO 1998). In Colombia, the Earthquakes, for example, can cause the
potential communicable disease out- public health situation also has improved, release of soil containing spores, such as
breaks after a disaster. While it is true yet infectious diseases still represent one coccidioides immitis, causing clinical
that the potential for outbreaks and even of the principal reasons for medical care coccidioidomycosis. This occurred
epidemics of infectious disease exists and are one of the top five causes of death following the Northridge, CA earthquake
after any natural disaster, the actual (Shoaf 2000). of 1994 causing a small outbreak of
occurrence of such outbreaks has been Both Colombia and Honduras are coccidioidomycosis in a community in
rare (Noji 1997). In order for the risk of endemic regions for dengue fever; in 1998 Southern Ventura County. Other natural
epidemic to exist, the disease of concern in fact, Armenia, Colombia had an hazards that have the potential of causing
needs to exist in the population prior to epidemic. Both the Colombian earth- acute illness include volcanoes and
the disaster. quake and the Honduran hurricane wildfires which can cause both respira-
Following the earthquake in Turkey in produced conditions that could increase tory and ocular problems as a result of
October1999, there was a great deal of the vector, flies, which carry dengue. Since ash, smoke, and toxic gases.
speculation that outbreaks of cholera and the impacted area in Colombia was Extreme weather conditions are good
Spring 2000 59
Introduction associated with the impact of earthquakes
Each year millions of people are affected By Kimberley I. Shoaf, DrPH & Steven J. on human health, a key factor associated
by natural and manmade disasters around Rottman, MD, FACEP, UCLA Center for
with fatal injuries in earthquakes is
the world. 1999 was an example of the building collapse.
Public Health and Disaster Relief
devastation that natural hazards can have Earthquakes in which a large number
on humanity. Tornados, hurricanes, heavy of buildings collapse result in many more
rains, and earthquakes resulted in tens of deaths than those where there is minimal
thousands of deaths and many more relationships are not linear, however. For collapse. Building collapse is correlated
affected. Close to a million people have example, not all earthquakes result in with the magnitude of the event, its
found themselves homeless, economically large numbers of injuries or deaths and proximity to the building, soil conditions,
impacted, or injured because of these hurricanes can, in fact, result in large and the construction practices utilized
disasters. Indeed, disasters would not be numbers of fatalities. (Bourque 1998). The combination of a
disastrous if it were not for their effect Tropical storms and hurricanes large earthquake, in close proximity to a
on the human population. While disasters The number of fatalities associated with population center, built upon soft soil,
cause problems that exact a human toll hurricanes in the western hemisphere using construction practices which do not
and are amenable to public health inter- have decreased dramatically with the employ anti-seismic reinforcements, can
ventions, the application of public health advent of improved storm tracking and result in unimaginably large number of
principles to disaster management has the issuance of hurricane warnings. fatalities.
been minimal. This paper explores the Hurricane Mitch, however, provided a The 1999 earthquake in Turkey is an
public health effects of natural disasters stark reminder that hurricanes remain a example of the potential that earthquakes
and some of the public health principles significant threat to life in that region of have for death and destruction. A magni-
which can be applied to disaster manage- the globe. In October 1998, Hurricane tude 7.4 earthquake occurred on the North
ment. Mitch devastated Central America. Even Anatolian Fault, near the town of Gölcük
The impact of natural hazards on the though the hurricane had been tracked, on August 17, 1999. Hundreds of apartment
publics health can be divided into four warnings were not issued to the popu- buildings, constructed out of reinforced
categories: lation (Corrales 1999). In Honduras alone, concrete collapsed on their sleeping
direct impact on the health of the 8000 people were killed as a result of occupants. The results were an estimated
population flooding and landslides. The pattern of 17,000 deaths with an additional 10,000
direct impact on the health care system the injuries and deaths associated with people missing and presumed dead.
indirect effects on the populations Hurricane Mitch was also different from Another 24,000 individuals were treated
health other hurricanes. Generally hurricane- for injuries (MMWR1999). An earthquake
indirect effects on the health care related mortality has principally been of similar magnitude occurred a month
system. associated with drowning from storm later in Taiwan. The 7.6 Mw earthquake
surges (Noji 1997). But a large number of also struck in the middle of the night killing
Direct impact on the health of a
the Hurricane Mitch fatalities were approximately 2400 people. While as many
population
associated with inland flooding and as 5000 buildings reportedly collapsed in
The most obvious impact on the health
mudflows resulting from 5 days of Taiwan, many of them were non-engi-
of a population affected by a disaster is
torrential storms leaving behind 30 inches neered low-rise buildings as compared to
that of injuries and deaths that can be
of rain (PAHO 1999). The sustained high the reinforced concrete buildings in
attributed directly to the disaster. Each
winds associated with these storms also Turkey which were more deadly (Goltz
year, approximately 300 natural disasters
have the potential of causing blunt trauma 1999).
occur worldwide, exacting a human toll
from flying debris as well as from Even a relatively small earthquake can
of approximately 250,000 lives. In the past
structural collapse of buildings. Several have devastating effects. On January 25,
20 years, natural disasters have claimed
deaths in Hurricane Andrew in South 1999 a magnitude 5.9 earthquake occur-
the lives of close to 3 milliion people and
Florida in 1992 were attributed to the high red in the coffee growing region of
have negatively affected the lives of at least
winds associated with that storm (Noji Colombia. The relatively moderate
800 million more (Noji 1997).
1997). earthquake however struck an area that
Injuries had soil conditions which exacerbated the
Different types of disasters result in Earthquakes shaking experienced in the city of
different patterns of injury and these, in Injuries and the resulting fatalities Armenia. The construction practices
turn, produce variable levels of morbidity associated with earthquakes vary tremen- prevalent in building in the region did
and mortality. Generally it is believed that dously from one event to the next. Both not include any codes for anti-seismic
earthquakes and rapid flooding (i.e. the number and severity of injuries are reinforcement until 1986. As a result of
tsunamis and flash floods) are capable of related to a number of factors including the earthquake, hundreds of reinforced
producing large numbers of deaths. the magnitude of the earthquake, its concrete buildings collapsed, killing
Earthquakes and high wind events (such proximity to a populated area, the soil type, nearly one out of every 250 people in this
as tornados) are capable of producing building construction, time of day and community of 250,000 (Shoaf 2000).
large numbers of severe injuries requiring population characteristics and behaviors. The force of the earthquake is not the
intensive care (Noji 1997). These While there are a large number of factors only cause of death. Secondary hazards
58 Australian Journal of Emergency Management
, such as firestorms and tsunamis can also typhoid would occur as a result of the smaller the ability to provide vector
wreak havoc and a high death toll. It is large number of dead bodies. While there control in the region was greater. Sur-
estimated that as many as 10% of the are sporadic cases of typhoid in Turkey it veillance in Colombia demonstrated that
deaths in the Kobe earthquake were a is not a disease that is common there. One there was no increase in either classic or
result of the fires that ignited from individual was treated for typhoid by hemorrhagic dengue fever. Surveillance
ruptured gas lines. Rubble in the narrow emergency medical personnel following in Honduras however, demonstrated a
streets restricted the fire departments the earthquake, although the case was not Bimodal increase in cases of dengue: a
access to the fire, allowing it to spread confirmed as typhoid and the source of small increase immediately following the
across large sections of the city. contagion was not identified. A single case hurricane and a second increase in
In 1998 a magnitude 7.0 earthquake of typhoid in an area where sporadic cases January, 1999. The destruction of the
struck off the coast of Papua New Guinea. exist is not an outbreak. However, that case transportation and health care sectors
While the quake was felt, it did no damage fueled a great deal of commotion in the from massive flooding made it more
to the small houses in the villages off the media and the public health community. difficult for the health care sector to
coast. However, 15 minutes later three Dr. Claude deVille de Goyet of the Pan- respond to a disaster of such magnitude.
tsunamis struck the coastal villages. It is American Health Organization wrote an While Colombias public health infra-
estimated that as many as 3000 of the 8000 op-ed piece for the New York Times, structure was most likely a contributing
inhabitants of the region died as a result which unfortunately was not carried. In factor in the absence of post-earthquake
of the waves, which exceeded 12 meters that piece, Dr. de Goyet talked about the disease outbreaks, a disaster may increase
(USC 1998). Many of these deaths were a myth that disasters result in epidemics of the demands on an already weak public
result of the force of such a large amount infectious diseases and emphasized health infrastructure in developing
of water surging against the body. For instead the need for maintenance and countries. This may result in a shift in
those who survived the force, many quick restoration of sanitary services and priorities away from building com-
drowned, as they were unable to swim. potable water to the affected population, municable disease prevention and control
Non-fatal injuries also vary in severity as well as surveillance of its health status. programs in non-disaster times, to more
and number and are dependent on a Dr. de Goyet also admonished post-diaster urgent efforts to respond to a legitimate
number of variables. Unlike fatalities the efforts aimed both at the quick disposal increase in cases when a disaster occurs
critical factor is not necessarily building of bodies as a public health measure, as (Richman 1993).
collapse or even damage to structures. well as large immunisation campaigns No outbreaks of infectious disease,
Non-fatal injuries can range from very geared to counter epidemics of specific such as dengue, have been reported
minor injuries such as lacerations and infectious diseases that simply do not following similar disasters in the United
injuries to soft tissue to such life- occur following these incidents. States or other developed countries. This
threatening injuries as trauma to internal A more accurate reflection of how well is simply because infectious diseases do
organs. Whereas fatal injuries are usually a community can withstand the adverse not represent major causes of illness or
caused by building damage, these non- health effects caused by a disaster may be death in the United States. While dengue
fatal injuries appear to be more directly found in the strength of the public health fever is a possibility in parts of the United
associated with ground shaking. The system in place prior to the disaster. States, particularly southern Florida,
Northridge earthquake of 1994 provides Consider the occurrence of dengue fever because the occurrence rate is small, any
an example of this. Whereas a majority of following both Hurricane Mitch in outbreak detected by surveillance would
deaths occurred in collapsed buildings, Honduras and the earthquake in Colom- most likely also be small and not expected
most non-fatal injuries (both those who bia. be a large additional burden on a public
were hospitalised and those who sought Honduras has a public health system health system that is trying to provide
treatment elsewhere) were more asso- which is making great strides in im- basic necessities in response to a disaster.
ciated with non-structural responses to proving the health situation for its
ground shaking. The two major causes of population. In the last 10 years, both Acute illnesses
non-fatal injuries were being struck by maternal mortality and infant mortality In contrast to infectious diseases, disas-
objects (or running into them) and falls have decreased steadily in Honduras. ters do have the potential for other types
(Peek-Asa et al. 1998, Shoaf et al. 1998). However, infectious diseases continue to of short-term impact on the populations
be the principal reason for medical care health. Some disasters have the potential
Communicable diseases and hospital admission and represent six for directly or indirectly causing acute
Many believe that the primary role of of the top ten causes of death in the illnesses in an exposed population.
public health in disasters is to control country (PAHO 1998). In Colombia, the Earthquakes, for example, can cause the
potential communicable disease out- public health situation also has improved, release of soil containing spores, such as
breaks after a disaster. While it is true yet infectious diseases still represent one coccidioides immitis, causing clinical
that the potential for outbreaks and even of the principal reasons for medical care coccidioidomycosis. This occurred
epidemics of infectious disease exists and are one of the top five causes of death following the Northridge, CA earthquake
after any natural disaster, the actual (Shoaf 2000). of 1994 causing a small outbreak of
occurrence of such outbreaks has been Both Colombia and Honduras are coccidioidomycosis in a community in
rare (Noji 1997). In order for the risk of endemic regions for dengue fever; in 1998 Southern Ventura County. Other natural
epidemic to exist, the disease of concern in fact, Armenia, Colombia had an hazards that have the potential of causing
needs to exist in the population prior to epidemic. Both the Colombian earth- acute illness include volcanoes and
the disaster. quake and the Honduran hurricane wildfires which can cause both respira-
Following the earthquake in Turkey in produced conditions that could increase tory and ocular problems as a result of
October1999, there was a great deal of the vector, flies, which carry dengue. Since ash, smoke, and toxic gases.
speculation that outbreaks of cholera and the impacted area in Colombia was Extreme weather conditions are good
Spring 2000 59
