Addressing Water-borne Diseases in Humanitarian Response Situations

Abstract 

The research found out that the past century was characterized by natural disasters that led to the outbreak of water-borne diseases. The outbreaks that occurred were difficult to detect as surveillance systems could not be installed immediately. Further, these situations left thousands of people at a risk of contaminating diseases such as cholera and typhoid. Additionally, the investigation revealed that during these disasters, governments tried to prevent such outbreaks by vaccinating people in the affected areas, however they faced several hindrances in the efforts. One of the hindrances that the research found out was low adaptive capacity of the targeted population. Disasters such as tsunamis and floods immensely contributed to low levels of access to improved sanitation. For example, in 2010, the earthquake in Haiti resulted in catastrophic spread of water borne diseases. The outbreak led to the establishment of the National Plan of Action for the Elimination of Cholera in Haiti 2013-2022. The plan’s aim was to eliminate cholera in Haiti and “build back better”. The long term goals of post-crisis recovery are to identify vulnerabilities causing epidemics and steps towards avoiding them. Post-crisis recovery efforts involved evacuation of people from affected areas, provision of social amenities to victims and prevention of the spread of diseases in highly populated areas. The unprivileged people in the society were the most vulnerable as they did not have access to improved sanitary infrastructure. People suffering from chronic diseases were vulnerable too. Victims suffering from conditions such as cancer and diabetes experienced a lot of trouble as they could not access routine healthcare. Such pre-existing conditions immensely increased the mortality rates during natural disasters. To complete this research, I conducted a literature search of peer-reviewed journal papers on the topic. The papers were chosen carefully to ensure that they were relevant to addressing water-borne diseases in humanitarian response situations. This research sought to explain how humanitarians and aid workers addressed waterborne diseases in humanitarian response situations and important issues for preparedness for disasters. 

Keywords : Natural disaster, epidemics, outbreak, prevention, control and communicable diseases. 

Introduction  

Natural disasters such as tsunamis, floods, earthquakes, floods and volcanic eruptions are responsible for catastrophic economic, social and health effects. According to Watson et al, (2007) disasters are responsible for the death of I billion people in the last two decades and the loss of billions of dollars. Due to the lack of proper infrastructure, developed countries are immensely affected. People suffering from chronic diseases are vulnerable during natural disasters. Conditions such as shortage of water and food exacerbate chronic illnesses. These people are vulnerable due to lack of prescribed routine care (Mensah et al., 2005). The deaths are a result of injuries incurred during the disasters, drowning and communicable diseases. 

Natural disasters affect both the developed and the developing countries. Countries such as the United States and Japan have been struck by natural disasters. The United States was hit by hurricane Katrina in 2005 proving that even developed countries are vulnerable (Kouadio, et al., 2014). Although natural disasters result in a lot of losses, the media is responsible for over-emphasizing thus leading to panic and avoidable health activities. The long-term effects of disasters are destruction of farming activities leading to starvation, disruption of transport activities and collapse of healthcare systems. Disease outbreaks are usually caused by overcrowding of displaced people, exposure to disease pathogens, poor nutritional status, poor sanitation, low levels of immunity and disrupted healthcare activities. 

Discussion and Methods 

Methods 

Peer-reviewed papers were used to complete this assignment. These papers were retrieved from the following sources: PubMed, the International Journal of Disaster Prevention and Management, International Journal of Environmental Research, The American Journal of Tropical Medicine and Hygiene, the Norsk Geografisk Tidsskrift-Norwegian Journal of Geography, the Harvard University Press, and the International Journal of Physical Distribution & Logistics Management. The keywords that were used are ‘natural disaster’, ‘epidemics’, ‘outbreak’, ‘prevention’, ‘control’ and ‘communicable diseases’. 

Selection Criteria 

All the resources that were used address how water-borne diseases are dealt with during humanitarian crises. Resources addressing disaster that occurred before 2000 were not used. 

Findings 

Out of the fifty articles that had been selected, only fifteen were used. The research focuses on the effects of natural disasters pertaining to water-borne diseases. It shows how the after-effects of natural disaster lead to the spread of these diseases. This discussion focuses on the role of humanitarians in response to natural disasters. 

Water-borne diseases caused by the after effects of natural disasters. 

Diarrheal diseases are the most common during natural disasters and account for 40% of lives lost (Connoly et al., 2005). The outbreak and spread of these diseases is associated with fecal contamination of drinking water and ingestion of contaminated food. These diseases are not directly a result of natural disaster but after effects such as overcrowding of displaced people. Reports of diarrheal diseases after disasters are more common in developing countries. Lack of proper sanitation infrastructure is the main cause for higher rates of diarrheal diseases in developing countries. Humanitarian’s aid is also inaccessible due to poor transport infrastructure. Poor sewage disposal systems are also a major contributing factor mainly in villages where only pit latrines are used. The percentage of people of have access to functioning sanitation infrastructure in the Western hemisphere is lowest in Haiti (Gelting et al., 2013). After the 2010 earthquake that hit the country, cases of outbreaks were reported. The spread of the disease was aggravated by the poor sanitation services in the country. The outbreak resulted in more than half a million cases of cholera and 8,111 deaths (Gelting et al, 2013). In 2004, more than 17,000 cases of cholera were reported in Bangladesh (Qadri et al., 2005).The 2004 tsunami that occurred in Indonesia resulted in a water shortage crisis as the residents depended on shallow wells for water (Clasen & Smith, 2006). Nolz, (2010) emphasizes on the importance of planning water distribution tours to areas facing water shortages due to natural disasters. As stated by Davies et al., (2015), the larger percentage of Cambodia’s population lives in poverty. The country is prone to natural disasters due to climate change making its residents very vulnerable. Most of the country is a flood plain and 80% of the population lives in the flood prone area (Davies et al., 2015). The people living in these places are highly vulnerable due to widespread poverty, poor health, poor governance, and overreliance on agriculture. These vulnerabilities result into high mortality rates of children due to diarrheal diseases. 14% of mortalities among children below the age 15 can be attributed to poor sanitation conditions (Davies et al., 2015). Cambodia is ranked eighth by the Maplecroft’s Climate Change Vulnerability Index in terms of vulnerability to climate change (Davies et al., 205). The country is highly vulnerable to floods between May and November as it experiences 85% of annual rainfall during these months. Residents of disaster prone areas should ensure that they have advanced water and sanitary infrastructure to reduce the after effects of disasters. 

Outbreak of communicable diseases cause panic among the public and the government. Fear of spread of cholera results in mass vaccination to control it. Following the 2004 tsunami in Indonesia, the government decided to conduct a mass vaccination (Chaignat et al, 2008). Oral cholera vaccines were used on the survivors of the tsunami. The vaccination faced a lot of challenges leading to increased costs and time taken to administer the vaccine. Communicable diseases are usually spread by presence of corpses in the affected areas and lack of access to improved sanitary infrastructure. Presence of dead bodies in areas recovering from a disaster may cause the residents to panic in fear of disease outbreaks (Goyet, 2004). The diseases are however only spread by the bodies that had been infected. Dead bodies in affected areas should be managed efficiently to avoid the spread of communicable diseases. Highly populated areas are usually at a higher risk of disease outbreaks. The proximity to functioning sanitary infrastructure is associated with the transmission of diseases. Disasters that do not result in displacement rarely cause outbreaks. Natural disasters are associated with outbreaks of diseases such as diarrheal diseases, dengue fever, typhoid fever and malaria. The spread of these diseases can be prevented only by establishment of healthcare services and provision of sanitary infrastructure. Lack of infrastructure such as working latrines rapidly increases the spread of the diseases. 

Response to Natural Disasters 

The effects of disasters can be rapidly reduced if the appropriate interventions are put in place. Appropriately responding to natural disasters has been known to immensely reduce the resultant morbidity and mortality. Intervention efforts have to be conducted in an accurate manner to ensure that the mortality and morbidity rates are reduced. Diarrheal diseases are the most common causes of morbidity and mortality during disasters (Waring & Brown, 2005). Countries should set up appropriate measures for disaster response to ensure communicable diseases do not spread after natural disasters occur. Humanitarians play an important role in reducing the effects of natural disasters. Humanitarian aid should be conducted in a timely and structured manner to ensure quality of response. Disasters are characterized by complex emergencies thus demanding organizational coordination. According to Leaning et al., (1999) these complexities are associated with destruction of institutions and breakdown of the fabric of the society. Taylor, (2009) suggests that organizations offering humanitarian aid should have a common goal and develop plans directed at achieving those goals. Humanitarian organizations should observe a form of hierarchy as a hierarchical organization has formal rules for communication (Taylor, 2009). Effective communication between humanitarian organizations responding to disasters is vital towards achieving their main aim of reducing mortality and morbidity among the affected population. Although a hierarchical model is important, it slows down operations due to the top down communication process that will be followed. This model could otherwise result in higher mortality rates if not established carefully. Recovery efforts should focus on finding long term solutions to address the predisposition of disaster prone areas (Khasalamwa, 2009). Identifying and eliminating vulnerabilities is essential as it protects people living in disaster prone areas from post-crisis effects. 

Conclusion 

Waterborne diseases can result in numerous fatalities if they are not handled carefully. People living in disaster prone areas should observe standard levels of hygiene and sanitation before, after and during natural disasters. As stated before, lack of advanced water and sanitation infrastructure are the main causes of the outbreak of waterborne diseases. Countries should develop a preparedness and response plan to ensure they are ready for disasters. Preparedness is the key to overcoming any disaster. 

Humanitarian organizations should ensure that aid is delivered timely and in an organized manner. Organizations offering aid should develop common goals to ensure that disasters are managed in an appropriate manner. Education on hygiene should be a priority to prevent spread of communicable diseases. 

Further research on disaster preparedness is urgently required. Countries should embark on analyzing the natural disasters that they are prone to in order to develop disaster preparedness plans customized towards those epidemics. A disaster preparedness plan ensures that a country can handle any epidemic without depending on foreign aid. 

References 

. Chaignat, C. L., Monti, V., Soepardi, J., Petersen, G., Sorensen, E., Narain, J., & Kieny, M. P. (2008). Cholera in disasters: do vaccines prompt new hopes?. Expert review of vaccines, 7(4), 431-435. 

Clasen, T., Smith, L., Albert, J., Bastable, A., & Fesselet, J. F. (2006). The drinking water response to the Indian Ocean tsunami, including the role of household water treatment. Disaster Prevention and Management: An International Journal, 15(1), 190-201. 

Connoly MA, Gayer M, Ryan MJ, 2004. Communicable Diseases in Complex Emergencies: Impact and Challenges. Lancet364, 1974-1983. 

Davies, G., McIver, L., Kim, Y., Hashizume, M., Iddings, S., & Chan, V. (2015). Water-borne diseases and extreme weather events in Cambodia: Review of impacts and implications of climate change. International journal of environmental research and public 

Gelting, R., Bliss, K., Patrick, M., Lockhart, G., & Handzel, T. (2013). Water, sanitation and hygiene in Haiti: past, present, and future. The American journal of tropical medicine and hygiene, 89(4), 665-670. 

Khasalamwa, S. (2009). Is ‘build back better’a response to vulnerability? Analysis of the post-tsunami humanitarian interventions in Sri Lanka. Norsk Geografisk Tidsskrift-Norwegian Journal of Geography, 63(1), 73-88. 

Kouadio Isidore, Syed Aljunid, Taro Kamigaki, Karen Hammad & Hitoshi Oshitani, 2014. Infectious Diseases Following Natural Disasters: Prevention and Control Measures. Expert Review of Anti-infective Therapy. 10: 1, 95-104. 

Leaning, J., Briggs, S. M., & Chen, L. C. (Eds.). (1999). Humanitarian crises: the medical and public health response. Harvard University Press. 

Mensah, G. A., Mokdad, A. H., Posner, S. F., Reed, E., Simoes, E. J., Engelgau, M. M., & Vulnerable Populations in Natural Disasters Working Group. (2005). When chronic conditions become acute: prevention and control of chronic diseases and adverse health outcomes during natural disasters. Preventing chronic disease, 2(Spec No). 

Nolz, P. C., Doerner, K. F., & Hartl, R. F. (2010). Water distribution in disaster relief. International Journal of Physical Distribution & Logistics Management, 40(8/9), 693-708. 

Qadri F, Khan AI, Faruque ASG, Begum YA, Chowdhury F, Nair GB. Enterotoxigenic Escherichia coli and Vibrio cholera diarrhea, Bangladesh. Emerg Infect Dis 2005:11:1104-7 

Seybolt, T. B. (2009). Harmonizing the humanitarian aid network: Adaptive change in a complex system. International Studies Quarterly, 53(4), 1027-1050. 

Waring, S. C., & Brown, B. J. (2005). The threat of communicable diseases following natural disasters: a public health response. Disaster Management & Response, 3(2), 41-47. 

Watson, J. T., Gayer, M., & Connolly, M. A. (2007). Epidemics after natural disasters. Emerging infectious diseases, 13(1), 1.