Here’s a very scary interactive graphic on natural disasters from the New England Journal of Medicine (NEJM) that tracks changes in the number and economic cost of such events from 1950 to 2012.  Published in the same week that we are learning about the devastation in the Philippines from SuperTyphoon Yolanda, said to be the strongest hurricane ever to strike land, this graphic shows a relentless increase in total natural disasters, with the bulk of the impact being from climate-related (hydro-meterologic) disasters.

From NEJM 11/7/2013. Click graph to see free text version of the article
From NEJM 11/7/2013. Click graph to see free text version of the article

Jennifer Leaning MD and Debarati Guha-Sapir PhD provide a thought-provoking review of Natural Disasters, Armed Conflict, and Public Health” in the 11/7/2013 Issue of NEJM.  In that review they make some important points worthy of discussion.


Armed conflicts

First, with regard to armed conflicts, such as we are currently seeing in Syria, it is important to note that combat-related injuries and deaths are not the only source of morbidity and mortality.  In fact, malnutrition and infectious disease are key contributors.  Disruptions in traditional food supplies as well as challenges to humanitarian relief mean that both internally and externally displaced persons are starving with consequences most severe for the very young and the very old.

Breakdown of the healthcare systems of affected countries mean people are unable to access care for both war-related injuries, but also for other health conditions such as infections, chronic disease, and non-combat injuries.  Public health programs, such as vaccination programs, may come to a halt allowing resurgence of previously controlled childhood diseases, such as measles and Rubella.  A frightening example of this is the re-emergence of polio in unvaccinated children in Syria.


Natural disasters

When it comes to natural disasters, there are several phases that need to be addressed.  The first is the acute care of the population injured by the disaster.  This is followed in short order by illnesses related to the disruption of the region’s infrastructure – water supply, health care facilities, food.  The recent disaster in the Philippines is illustrative.  It is estimated that 10,000 people were killed by the powerful storm and many thousands more injured.  Several days after the storm, we are beginning to see reports of dysentery – the result of ingestion of contaminated water and food.  Widespread damage to the healthcare infrastructure exacerbates both phases and results in more deaths than would have otherwise occured.

Humanitarian efforts get mobilized quicker than ever, but, the article points out, it is less effective than it otherwise could be because of a lack of coordination and a failure to ensure that efforts are aimed not only at relief but also at supporting and rebuilding the country’s public health and health care infrastructure. The public health community learns a lot from analysis of each disaster’s response, but the size and frequency of natural disasters could outpace our ability to to get substantially better before the next disaster strikes.

The article correctly closes by noting that “in the years ahead, the international community must address the root causes of these crises….Humanitarian relief will always be required,” but “there is a demonstrable need…to place greater emphasis on prevention and mitigation.”


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