The government must take action to address the cause of the bushfires and support those providing care

As we celebrated the start of the new year in Australia, images of fireworks over Sydney Harbour were in stark contrast to those of people sheltering on a beach from bushfires in Victoria. The devastation caused by the bushfires has dominated news headlines here and around the world, with over 1400 homes lost, millions of acres burnt, and at least 19 deaths since the start of the fire season.

Many are quick to point out that bushfires are a part of Australia’s natural ecology. The public is well-educated in the prevention and response to bushfires—residents in at-risk areas are advised to make a “bushfire survival plan,” total fire bans are regularly in place during the summer months, and billboards on the motorway illustrate how far a bushfire can jump. But the recent fires are the most extensive ever seen in Australia, which has fuelled the debate about the role of climate change and raised concerns about the impact on the health of those affected.

The health effects of bushfires are significant. Those at the fire front run the risk of serious injury or death from radiant heat, burns, smoke inhalation, heat stress, and dehydration. Communities affected by a bushfire face the same the public health issues as any evacuation, combined with the risk of a failed or contaminated water supply. 

Bushfire smoke contains very small particles and can travel hundreds of kilometres, causing irritation of the eyes and nose, and exacerbating conditions such as asthma, COPD, and ischaemic heart disease. Air pollution concentrations are significantly raised by bushfire smoke and are associated with increased presentations to hospital emergency departments. The Australian Medical Association (AMA) has warned that the length and density of smoke exposure is a new and possibly fatal health risk.

The AMA also points out that the mental health burden of this disaster on communities will be considerable. The fire service tells those who choose to stay and defend their home that doing so “could be one of the most traumatic events of [their] life.” The stress of experiencing a bushfire can affect people psychologically, socially, and economically, says Doctors for the Environment Australia. A consultant emergency physician in Canberra told The Guardian “I don’t think you can underestimate the psychological impact of not just the smoke but the existential threat of fire.” People may lose loved ones, homes, pets, and livestock, and may be affected just by seeing images of devastation on their screens—for those affected by bushfires in the past the repeat of events elsewhere may bring back traumatic memories. 

The Royal Australian College of General Practitioners (RACGP) sets out guidance on consulting with patients who have been affected by a bushfire, with an emphasis on supporting patients to deal with the traumatic experience they have been through. It also urges doctors who have been impacted by bushfires to take care of their own health. And there are calls for government funding for provision for counselling services for firefighters dealing with the long-term psychological effects of fighting fires.

The government’s overall response to the current crisis has been heavily criticised. Speaking on the radio yesterday, the New South Wales fire commissioner said the response of the Australian Prime Minister, Scott Morrison, to the fires was like US President Donald Trump declaring that multiple shootings are nothing to do with guns. “We have to talk about climate change, because our bushfire situation in Australia has changed forever,” he said. 

In September 2019 the Australian Medical Association joined the BMA and the American Medical Association in recognising climate change as a health emergency. In December, along with 27 other health and medical groups, it signed a joint statement calling on the government to respond to the public health emergency created by the ongoing air pollution from bushfire smoke by taking appropriate action on climate change.

Australia was recently placed 57th out of 57 countries on climate change action, a finding that Morrison does not accept as credible. But as communities continue to flee from bushfires the government cannot escape the reality of the significant health impact of this crisis, and must take action to address the cause and support those providing care.

Marika Davies is a freelance journalist and medicolegal adviser for MDA National, Australia.

Competing interests: MD is employed as a medico-legal adviser by MDA National, Australia and does consultancy work for Medical Protection.