Disaster Epidemiology Lessons From Bam Earthquake Dec 26, 2003 Iran

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Disaster Epidemiology Lessons
From Bam Earthquake
Dec 26, 2003 Iran Part 7
Health sector in Bam earthquake
A. Ardalan MD, MPH, PhD student in Epidemiology
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• Learning objectives
• To view the structure of health system in Bam
• To understand the barriers of efficient health
• services delivery in Bam
• To learn about mental health interventions in
  Bam
• To learn about surveillance system in Bam
• To learn about health related concerns in Bam

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Geographic classification
Strategies for service delivery
Physical space
Instruments
Health service structure
Workforce composition
Workforce tasks
Duration of activities
Workforce training
Volunteer peoples
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Population movement after the earthquake
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Zones
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Earthquake-stricken area
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Population Movement Major concern and barrier
for effective services delivery in Bam

• Invasion of poor people from neighboring
• areas to Bam

110,000 Population before the earthquake
90,000 Population at the
1.5 months after the earthquake
40,000 Number of death
(?)
-
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Population Movement 2) Changing living places
inside the bam

• The most important reasons
• Poor environmental health condition of previous
  living
• zone (85)
• Lack of accessibility to latrines (73)
• Recurrent referral of health personnel for
  census (54)
• Being interested in being in front of their own
  damaged house (49)
• Lack of sufficient environmental space for
  living (26)

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Cumulative percent of the first time health
services delivery to the earthquake-stricken
households in Bam till 20th days of
post-disaster period
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The overall satisfaction of the
earthquake-stricken people from health services
delivery
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The needs (expressed demands) of Bam
earthquake-stricken households on 19th and
20th days of post-disaster period
Bath room 74
Food 69
Clothes 68
Heaters 62
Security 60
Latrine 49
Money 47
Others
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The frequency of illnesses in the
earthquake-stricken households till 19th and
20th days of
post-disaster period
Illness
Suicide thought 5
Pregnancy 3
Low back pain 2
GI bleeding 1.5
Bloody diarrhea 1.5
Suicide attempt 1
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The needs (expressed demands) of Bam
earthquake-stricken householdson19th and 20th
days of post-disaster period
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Main barriers in health services delivery in Bam
earthquake-stricken households, during first 20
days of post-disaster period
Transportation
Unavailability of required services
Unfamiliarity with health and
medical centers
Dissatisfied from
previous services
Inappropriate time
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• Some points about accommodation status of
  population
• Determinants of aggregation places
• Distances of tents
• Risk of injuries
• Cultural values

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Social problems of earthquake-stricken households
in Bam till 20th days of post-disaster period
Violence Physical or psychological aggression
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• Substance abuse in Bam
• Opium abuse
• Prevalence before the earthquake
• 30 male, 5 female (anecdotal evidence)
• Norm culture
• A major problem in the treatment
• of hospitalized patients

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Changing the pattern of substance abuse in
Bam
Inadequate withdrawal services
Security concern
Opium odor
Heroin Injection
High price of opium
Lack of money
Psychological consequences of earthquake
Low price of heroin
Unemployment
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• Psychological Problems in Bam earthquake
• A major consequence of disaster
• 40 PTSD
• Comprehensive Mental Health program by
• Office of MH at MOH
• MH and Social Working interventions
• by State Welfare Organization

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• Mental health interventions in Bam
• Office of Mental Health at Iranian MOH has
• valuable experiences on MH interventions
• in disaster situations, based on previous
• earthquakes in Iran.
• They are covering all population in Bam
• by holding Relief groups to deal with
• PTSD, Depression and Suicide.

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Public address system Psychological importance

• Between families had asked for news
• about their relatives after the
• earthquake and used from provided
• list by governmental organization,
• 23 had found their response.

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Mass Graves in Bam Myths and Realities

• Political environment
• Bad odor
• Cultural beliefs

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Surveillance System
Collection of additional data
Current response
 Modify the system
Additional analyses
Iterative process
Evaluation the action
Further action
Disseminating the result
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• Evaluation of Designing Steps of the Surveillance
  System in Bam
• Establishment of objectives
• Development of case definitions
• Determining data sources
• Development of data-collection instruments
• Testing the field
• Development and testing of analysis strategy
• Development of dissemination mechanism
• Usefulness assessment of system

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Pre-requirements of Surveillance System in
disasters Stable health management in
crises Epidemiologic Knowledge Well-trained
field-team Network communication system
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• Some comments on the Disease Surveillance System
  in Bam
• Necessity of effective training program
• Improving effective communication system,
• especially internet
• Surrounding area should not be missed
• Integration of a JIT Outbreak Investigation
  System
• Using available data on referrals to clinics and
  
• health centers instead of the population for
• denominator of the indicators accompany by
• providing necessary information on referral
• pattern of people.

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• Future Potential Risk Factors of Outbreaks in Bam
  
• Hot weather
• Re-establishment of pipe-water supplies
• Low access to bathing facilities and risk
• of pediculosis and other cutaneous
• diseases
• Past history of epidemics of typhoid
• fever and cholera
• Endemicity of malaria and coetaneous
• leshmaniasis

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• Final Conclusion of the lecture
• Bam earthquake was a major disaster,
• resulting in mass destruction and a very
• high toll on human lives and health.
• These losses cannot be justified in light of
  existing scientific knowledge and expertise in
  disaster management.

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• Final Conclusion of the lecture
• The necessity of research-based information and
  better multi-disciplinary coordination was
  evident for more efficient service deliveries to
  poor people.
• Most of what can be done to mitigate injuries
  must be done before an earthquake occurs.

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• Final Conclusion of the lecture
• Because structural collapse is the single
• greatest risk factor, priority should be
  given to
• seismic safety in land-use planning and in the
  
• design and construction of safer buildings.
• The reconstruction of buildings according to
• modern standards will take decades to
• accomplish and will absorb a considerable part
  
• of the country's resources.

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• Final Conclusion of the lecture
• In disaster-prone areas, training and education
  in
• basic first aid and rescue methods should be an
  
• integral part of any community preparedness
• program.
• Better epidemiologic knowledge of risk factors
• for death and the type of injuries and
  illnesses
• caused by earthquakes is clearly an essential
• requirement for determining what relief
• supplies, equipment, and personnel are
• needed to respond effectively to earthquakes.

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• Final Conclusion of the lecture
• The integration of epidemiologic studies with
  those of other disciplines such as engineering,
  architecture, the social sciences and other
  medical sciences is essential for improved
  understanding of consequences following
  earthquakes.

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