This month’s blog will differ slightly from the previous ones in that it will refer to the current crisis in Turkey in the aftermath of an earthquake. The humanitarian crisis brought about by natural disasters touches on aspects of global health which we have mentioned in previous articles, and others more specific to the type of natural disaster which occurred.
The humanitarian and medical crisis into three phase: Phase 1 – immediate casualties. Phase 2 : hours and days post whereby impact medical relief teams provide life and limb saving care. Phase 3: the lack of healthcare personnel and infrastructure prevents the ability to provide long term care.[1]
Phase I: large amount of casualties, including health care providers, are the most immediate victims of an earthquake. The death toll and extent of destruction within a country is often not immediately clear: medical infrastructures, airport, roads, communication: phone , internet are often compromised. In this setting, coordination of search and rescue efforts are brought in from outside in order to assist those in need. When immediate relief efforts are brought into the country one main consideration which we use in ACLS and which is also applicable in this scenario : “ Is the Scene Safe?”. The aftershocks of an earthquake can be powerful and cause further casualties including the extra work force that was brought in. A present day example from Turkey is the premature removal of medical teams from the disaster site due to severe unrest and increasing violence in the area, potentially endangering the foreign teams.
Phase II: relief teams must reach the site, communicate at the location and set up some temporary medical facilities. Some military units will fly helicopters to the site which have easier access and do not need the same landing requirements as planes and bypass the unusable roads. Communication is often disrupted and unavailable, we recommend that teams bring satellite phones with them to the site.
Three main ways which have been used to provide emergent healthcare treatment during disaster relief: terrestrial hospitals, boats repurposed as hospital facility and flying hospitals[2]. The terrestrial hospitals , are the most commonly used, they are flexible in the location, size and function, they can be re-modeled according to need. Floating hospitals were initially used in Germany in the 1980s, using a cargo ship as a medical facility[3]. In 2010 in the aftermath of a major earthquake in Haiti, during the United States Navy deployed its USNS Comfort hospital ship. The boat was deployed within 72hrs of the earthquake and treated more than 850 civilians.[4] The large work area provided by cargo ships, as well as the location of the medical facility being slightly removed from the center of the disaster site provides a possibly safer environment. This healthcare facility is only relevant for locations in proximity of water which also provide a large docking area for the ship. With regards to timing, the deployment of floating hospitals can take longer than that of terrestrial ones.
Flying hospitals could provide a new efficient way of providing medical care either in the field or en route to a more more permanent care center.[5]
During this time, due to the lack of access to running water and proper sewage handling, infectious disease outbreaks such as cholera can surge as was the case in Haiti in 2010[6]. Medical professionals coming to the area must be prepared to handle in inherit infectious diseases present and the secondary ones which will come about due to lack of sanitation.
Phase III: lives have been lost, people have been displaced , causing both mental and physical morbidity for those who remain. Healthcare maintenance in the months to years following a natural disaster can be incredibly challenging. Destroyed medical facilities, limited access to pharmaceuticals, lack of medical personnel and the inability to perform scheduled vaccines for the population, remain large obstacles to be surpassed before the return to routine and proper preventative medicine.
Sustainability is key in the provision of health. Performing emergent surgeries is helpful but might not be sufficient, long lasting solutions for a populations who has both lost their clinics, hospitals, pharmacies and physicians must be found. Interventions and donations should be sensitive to the location in which they will be used. Using drones to drop off vaccines in difficult to access areas and having local staff deliver them could be one solution[7]. Partner’s in Health co-founder, the late Paul Farmer, emphasized the use of community workers in prevention and treatment of both acute and long term disease[8]. From maternal health to treatment of tuberculosis and HIV/AIDS, training of the local community in provision of care means non reliance on foreign workers.
After the rescue teams have left, the tent hospitals and boats are gone, the buildings need to be rebuilt, roads repaved and medical personal needs to repopulate the area. The aftershock of an earthquake is felt long after all the initial interventions have been completed. As we mentioned, outbreaks of infectious diseases, lack of proper healthcare maintenance facilities, no vaccination facilities, difficulty in access to basic medication, oxygen and clean water all hinder the normalization of health in hard hit areas.
As global health practitioners our efforts and strategies should span from acute to long term solutions in order to provide sustainable aid.
References:
[1] Charuluxananan S, Bunburaphong P, Tuchinda L, et al. Anesthesia for Indian Ocean tsunami-affected patients at a southern Thailand provincial hospital. Acta Anaesthesiol Scand. 2006;50:320–323.
[2] Chen X, Lu L, Shi J, Zhang X, Fan H, Fan B, Qu B, Lv Q, Hou S. Application and Prospect of a Mobile Hospital in Disaster Response. Disaster Med Public Health Prep. 2020 Jun;14(3):377-383. doi: 10.1017/dmp.2020.113. Epub 2020 Apr 22. PMID: 32317031; PMCID: PMC7251258.
[3] Zheng H, Tian F, Fan H, et al. Study on all-round arrival of military shelter hospital. Shandong Ind Technol. 2015;17:225.
[4] Walk RM, Donahue TF, Stockinger Z, et al. Haitian earthquake relief: disaster response aboard the USNS Comfort. Disaster Med Public Health Prep. 2012;6(4):370–377.
[5] est JS. Operation Blessing International’s Flying Hospital takes flight to new surgical frontiers on its first medical mission to El Salvador. AORN J. 1996;64(5):704-708.
[6] Steven J Hadeed, PhD, MPH, Katherine M Broadway, PhD, Kierstyn T Schwartz-Watjen, PhD, Bersabeh Tigabu, PhD, DVM, Ashley J Woodards, MPH, Anna L Swiatecka, PhD, DVM, Akeisha N Owens, PhD, Aiguo Wu, PhD, MD, Notional Spread of Cholera in Haiti Following a Natural Disaster: Considerations for Military and Disaster Relief Personnel, Military Medicine, 2022;, usac415, https://doi.org/10.1093/milmed/usac415
[7] Haidari LA, Brown ST, Ferguson M, Bancroft E, Spiker M, Wilcox A, Ambikapathi R, Sampath V, Connor DL, Lee BY. The economic and operational value of using drones to transport vaccines. Vaccine. 2016 Jul 25;34(34):4062-7. doi: 10.1016/j.vaccine.2016.06.022. Epub 2016 Jun 20. PMID: 27340098; PMCID: PMC5547752.
[8] Jerome G, Ivers LC. Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti. AIDS. 2010 Jan;24 Suppl 1(Suppl 1):S67-72. doi: 10.1097/01.aids.0000366084.75945.c9. PMID: 20023442; PMCID: PMC3169202.
About the author:
Chloe Pinto M.D. Resident in Anesthesiology, Pain and Intensive Care Medicine at Meir Medical Center, Israel.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None