Preparedness for Earthquakes and Tsunamis

ENVIRONMENT, 6 Apr 2020

Vidushi Prasad – TRANSCEND Media Service

The 2004 Indian Ocean Earthquake and Tsunami

Introduction

Tsunami is a seismic sea wave that originates due to an underwater disturbance in the form of earthquake, volcanic eruption, nuclear explosion or shifting of tectonic plates. In the beginning, tsunami looks like rapid rising tide waves that last for several hours with the height of nearly tens of meters. It destroys the ocean basins causing inland flooding and large-scale life destruction.

On December 26th, a magnitude of 9.1 earthquakes hit under the Indian Ocean on the west coast of Sumatra, Indonesia that created a gigantic tsunami. Indian Ocean Earthquake and tsunami of 2004 was one of the world’s largest devastating tsunami that killed more than 230,000 people, injured millions and lead to massive loss of property of $4,451.6 million. It was one of the greatest natural disasters that affected many countries including Indonesia, Sri Lanka, India and Thailand.

Such large-scale destruction can be prevented in future by the use of deep-ocean tsunami detectors that will be beneficial in the early evacuation of the population residing near coastal areas. The effective forecast report of the tsunami would help in planning the disaster needs such as rescue squads in the form of aircraft, boats, flooding-assistance, and high- profile vehicles. The transportation department could be prepared for flooding condition with barricades and water pumps. The early warning weather forecast could be helpful for school and office closure, these precautions would prevent the injuries or death caused when people stuck in the tsunami.

As per J. Leitmann’s article about lessons learned from the post-disaster response in Indonesia suggest the improvement in both relief and recovery efforts. During tsunami at Aceh and Nias, there were 130,000 deaths and 37,000 missing. This tsunami damaged agricultural land, fishery, and infrastructure and mainly affected the environment. Post-traumatic stress syndrome and depression are commonly seen in the survivors. As per WHO 20-40% of the population affected by tsunami suffered from the mild psychological problem, 30-50% were moderate to severely affected while 10-15% had a mental disorder.

This show that post-disaster requires not only the infrastructure reconstruction but also the support from medical and psychological health centres in the affected area. During the post-disaster phase in Aceh and Nias 42,000 houses were constructed, 524 school with 2,430 new teachers were re-established, 113 health clinics restored, 490 km roads were constructed, and agriculture sector was revived.(Leitmann, J. 2007).  Still there is need of improvement in all these areas as Aceh is the second poorest province due to low-income rates. There is a need to eliminate corruption and build strong economy and infrastructures that can withstand the earthquakes. It is essential to educate the residents near shores to be prepared for such future disaster. The government should demolish or reconstruct the abandoned and old buildings that have a risk to cause more damage during such disasters.

Data and Review

A study was conducted by Guha-Sapir D. and colleague to find the pattern of occurrence of diseases after a natural disaster. The study was focused on assessing the presence of chronic and acute diseases after 2004 Indian Ocean tsunami, which may not be directly caused by the tsunami but can be affected by the amount of health care needs that are available after the disaster. The chronic diseases such as diabetes, asthma, heart diseases require the regular medication for a person to maintain the stable health condition. But during a disaster it becomes difficult to follow the routine medication and treatment that worsen the condition. Some chronic disease such as HIV makes the patient more prone to infection by lowering the immune system. These populations are more vulnerable to infection that immerges in post-disaster situations.

During tsunami the hospitals experience loss of electricity, it even exacerbates the patient condition that is in emergency care units. The tsunami stuck regions even lose the transportation facility due to flooding and fallen off tress on the interstate highways which makes the medical facility and medication transportation more crippled. It is usually seen that people lose their houses and their belonging during a disaster or sometimes they even go missing during tsunami waves, losing all their medication. This all add up resulting in patients with chronic disease are forced to leave in a terrible situation. Even after the disaster it takes a long time to establish the proper transportation of medication from neighbouring states, by that time significant lose of health could occur in this patient with chronic disease. This studies goal was to collect data on which an appropriate emergency response and adequate public health preparedness can be planed.

Guha-Sapir D. and co-worker conducted a cross-sectional study that was based on the records collected by the International Committee of Red Cross from emergency hospital in Banda Aceh, Indonesia after 2004 tsunami. The hospital provided first and second-line treatment to the patient’s residing in that region. They desired to find the distribution of diseases after the tsunami. The records of a patient that visited between January 15 to 31 were included in the study. They collected the patients demographic and diagnosis information. The total of 1188 patient records was used for analysis, which was randomly selected from computer database to eliminate selection bias. They separated cases into two groups as chronic and acute diseases. The chronic illness includes diabetes, hypertension, asthma and renal diseases whereas the acute diseases include acute conditions such as upper respiratory tract infection. The multivariate logistic regression was used to determine the association between chronic illness and gender or age.

The results of this study found that 43.5% were the patient with chronic diseases. There were few trauma cases among women and kids. The odds of chronic disease increased by 16.4% per day after the tsunami till 23rd January with [95% (CI): 7.8-25.6%] and started decreasing after that by 13.1% per day [95% CI: 6.6-19.1%]. On the other hand, the odds of acute diseases were 34% lower in women than men [95% CI: 16-49%] whereas 4.3 times higher in kids than rest of the people [95% CI: 2.4-7.6]. This study had little information about psychiatric illness only 10% of the records in the study were of the mental illness patients.( Guha-Sapir D. 2007).

As per this study, the medical team should be prepared to provide the consultation and treatment needs of the patients with chronic diseases. The emergency preparedness team with health professional should be ready for all mediation to treat the patients with exacerbated chronic disease. During the tsunami, it is observed that patients with asthma have worsened their health, and many new cases of upper respiratory tract infection develop. These asthma cases occur due to inhalation of debris as high-velocity wind being inhaled during the tsunami. The delay in providing the proper medical treatment to acute diseases or trauma may result in disability.

There is a need to be prepared for the treatment of vulnerable population that include children, psychiatric patients and geriatric those are mostly affected by disasters. These psychiatric patients not always require psychiatric treatment but may need the social support to cope with their losses. To reduce the mortality rates the emergency care must reach the disaster site within few hours after the event. The data collected from public health care centres during post-disaster should be used to improve the emergency interventions. There is a need for similar studies as Guha-Sapir D. has conducted to develop evidence-based and cognitive interventions to overcome the medical and health needs of densely populated disaster prone area.

A study carried out by Souza R., et al. showed the evidence of mental health status of the vulnerable population in Aceh Province in Indonesia. The study had 262 participants in which 83.6% had severe emotional symptoms whereas 77.1% had depressive symptoms. Any form of disaster results in the tremendous loss. Loss can be in the form of material loss or personal or emotional loss, some of these lose can’t be compensated. Though government can reduce the distress that tsunami has caused in the families due to death of family member by monetary compensating or providing the job to the unemployed. Souza R and co-workers proved that tsunami deaths of household members caused a severe mental distress. (Souza R., et al., 2007)

Another study conducted by Musa, R., et al. suggest the psychological effect of the tsunami on the residents of Aceh and West Sumatra. They conducted a cross-sectional study on 12 to 75-year-old victims, using depression, anxiety and stress scale to measure the psychological status of the residents. Any form of disaster whether it is created by man or a natural disaster, it has its effect on human mind.

During a catastrophe, the family might lose their children that might badly affect the mental condition of the mother. They might have lost the person of the family on which family is economically dependent, that creates a further uncertainty of their future existence. Sometimes people encounter accident resulting in disability in the form of losing of extremity or eyesight that makes the person as well as the family depressed. It is not always the personal lose that mentally affects people, but sometimes it might be an economic loss. In developing countries majority of families are below poverty level, when such disaster occurs it result in loss of their properties, houses, cattle’s and farms. All these deprivations generate indefinite future resulting in future stress that might end up increasing suicide rates after post-disaster. The only variation the degree to which an individual get affected by a certain event depends on the situation a person’s face and the amount of psychiatric help available in that region.

They included 200 respondents using stratified cluster sampling. The people with previous mental disorder or having communication barrier were excluded from the study. As they were studying the effect of the disaster on a mental condition and including the previous mental disorder cases would have watered down the actual situation. The DASS-21 scale was used to measure the level of depression, anxiety and stress. Musa, R., and co-workers found that 19% of participants in the study had a high degree of depression, 51% had anxiety, and 22% were under stress. The factors that contributed to the psychological disturbance were unemployment, single, young age between 12 to 17 and women (p<0.05). The women are more prone to the post-disaster effects. This study draws a conclusion about post-disaster relief program should concentrate on the vulnerable population.

There is a need to develop more post-disaster surveillance as the disaster affected population remains mentally stressed even after many years of disaster. The government and humanitarian agencies can help the people in a disaster-prone area to cope up with the loss by providing the subsidy for their loss. The insurance claims should process the amount at a faster pace as people are already distressed. This money can bring stability in public to return to normal routine in their life by becoming an entrepreneur or reconstructing the houses. (Musa, R, et al. 2014)

There was an interesting research conducted by de Pee, S., et al. about the improvement of nutritional status after the tsunami in Indonesia. The nutrition becomes an important factor to be considered after a natural disaster, as most of the population losses the access to food and become undernourished. The undernourishment make this population susceptible to infection, 50% of children die due to this cause. It is usually observed that children are reluctant towards the nutritious food habits.

In developing countries, children are more prone to unhealthy food habits or even malnourished that aggravates the probability of disease among the children during a disaster, as there is a lack of food.  The emergency food aid made available to this disaster-prone region is for a limited period, which is not sufficient to provide the sustenance to the people who have lost their agricultural land and infrastructure. In tsunami the ocean water invades the agricultural field that disturbs the pH of the soil, resulting in barren land fields, these lands cannot even be used for grazing animals. To deal with this dearth of food emergency food response should provide nutritious food to the affected population. De Pee, S. and co-worker, used the data gathered from emergency response agencies such as Helen Keller.  They studied the percentage of acceptance of Vitality in the population.

The Vitality was a new product to provide nutrition to children after the tsunami. They evaluated 11 districts in March and April 2006 and found the percentage of children who consumed Vitality. There was 25% less anaemia in children aged six months to 59 months who received the Vitality. The proper nutrition is required for normal growth and development of the child. This normal development gets hinder in this disaster situations due to lack of nutritious diet. They interviewed the mothers during 2006 and concluded that they require more information regarding the new product. Even though this product was tasteless and can easily be mixed with any food still children refused to eat that product. Sometimes mothers do not have proper information and negligent about its use. This study demonstrated that providing the nutritional supplements after a disaster is possible and efficient (de Pee, S., et al. 2007).

Doocy, S., et al. conducted research to estimate the tsunami mortality and vulnerability by mapping the Aceh, Indonesia. They used GIS (geographic information system) to determine the mortality in the affected area which was based on vulnerability models and demographic model surveying the displaced populations. The estimate of mortality came to be 131066 as per demographic model that was close to the official record of 128063. It was concluded that GIS models can be used in early stages of disaster to determine the losses.

As after tsunami, most of the areas are flooded, and roads are blocked due to the debris of broken trees and houses making the transportation difficult. The surveillance process immediately after a disaster might be challenging. There might be a lot of hindrances making the residential area unapproachable due to water there might be mud on the roads that could increase the chances of skidding while doing a survey. Sometimes there may not be any road due to tsunami water in that area which increases the risk of drowning of surveillance vehicle while approaching the site. The safety concern for the officers doing the surveillance should be of priority.  In such situation, the GIS would be of great help while planning the emergency recovery plans. The effective surveillance is required in post-disaster condition so that future emergency preparedness can be planned in more effective and efficient way. (Doocy, S., et al. 2007).

Discussion

The various researchers conducted demonstrate the amount of destruction 2004 tsunami has caused. The studies surveyed on mortality and people displaced due to the tsunami. The natural disaster not only cause deaths and loss of property but also affects the psychological well-being of individuals who survive in the disaster for many years. While disaster people may lose their family member due to death or some may go missing which cause depression and stress. The tsunami leads to complete destruction of the city resulting in unemployment among the resident population that might cause anxiety for their future security. After a disaster, it is common that diseases spread rapidly because of the vulnerability of the population. Mostly the children become vulnerable to diseases because of lack of nutrition and poor sanitary conditions. The women and geriatrics are more vulnerable in a disaster situation. The chronic diseases aggravate in this condition due to the absence of medical care for a long time after the disaster.

After looking at these studies, the future implication is to increase more resources towards the post-disaster nutrition needs. The medical and health sector should be more efficient towards health needs of the vulnerable population including mentally challenged group. There is need of developing strong economy so that during the time of disaster the country would have economic stability. The disaster not only impact human lives but also has an effect on the environment.  The tsunami causes the death of animals as well as plants; this increases the risk of infection. The rivers get flooded and muddy with all dead leaves, dead animal and excreta, polluting the water. Thus, rivers and groundwater get contaminated with salt-water and sewage that increase the risk of infection. In this situation, water purification is required before consumption, by treating the water with some chemical agents that reduce the chance of infection.

As per FAO, 30% of farmland was affected on the north-east coast, and 20% were permanently damaged in Indonesia. The deforestation has increased the flooding and land sliding that suggests that there is a need to preserve natural resources. The coastal bed has been disturbed making the coast dangerous for the fisherman; it will take a long time to develop the normal and safe coastal line. There has been massive destruction of aquiculture area, mangroves, coral reefs, coastal area and the wastes in landfill sites were washed into the ocean by receding waves of the tsunami. This mangrove that had acted as a filter for oceans has been destroyed; it will lead to 90% contamination of ocean in future. (Srinivas, H., et al. 2008)

The study by Guha-Sapir D. shows survival bias among women and children as compared to men. As only a few children reported with trauma, as there is more mortality among children after the tsunami. The psychiatric diagnosis of the cases after the disaster was of less validation as per author, due to the difference in social and cultural aspects during a catastrophe. Whereas in the case of Souza, R. et al. research suggest that they have a sampling bias as women were in large number in their survey sample for the psychological study. They even oversampled elderly, as per demographic there is only 16% of residents that are older than 55 years.

In Musa, R., et al. study there is a recall bias due to the self-reporting questionnaire. It was difficult to determine the association between disaster and psychological effects. They did not specifically research on post-traumatic stress disorder. Doocy, S., et al. research determined that there were some limitations in as persons not displaced did not account in mortality model used for the survey. The GIS method employed in the research there was variance in scale and resolution of map layer than actual demographics.

There are several lessons learned from the response to this disaster. There is a need to respond quickly and efficiently to a future disaster. Surveillance should be planned in a way that it should not underestimate the mortality or trauma cases among a certain group of people. There should be the provision of immediate medical health care units for injured as well as persons with chronic illness this will prevent the rise of mortality rate during a disaster. The government should demolish the old and abandoned building that may present as the risk of accident in such earthquake and disasters. UN and other agencies should promote the survival oriented programs such as supplying nutritious food, shelter building, clothes and education regarding maintaining hygiene in these situations.

It is a difficult task to clean the contaminated rivers environmental consultation is needed in support of disaster management group to restore the environment. Coastal cleaning is needed. The government should give emphasis on promotion of protecting forests and mangroves. The agricultural lands are badly destroyed by saline water, which may result in famine conditions. The neighbouring country should collaborate with the disaster-prone country to prevent the risk of post-disaster mortality due to lack of food. The humanitarian agencies should work with these countries to provide food and water.

Limitation of this review is it is the secondary source rather than the primary source. It has some bias such as recall bias, survival bias and sampling bias. Still it is valid based on the data collected may not be accurate but shows nearly similar estimate. The validation of some data depends on the source such as hospitals from where the records are taken. The survey involved questionnaires that might induce recall bias when people have to remember the certain event of disease whether the onset was before or after the disaster incidence took place. There may be some bias induced while collecting the data such as gender or age prevalence in an area where the study is conducted.

Tsunami leads to a large number of mortality cases that resulted in a problem about the dead bodies’ management. The Future research should concentrate on managing such situation. The dead body management should be planed based on the socio-cultural background of the region. The culture should be respected while planning emergency response while handling the dead bodies of victims.  There should be the law for treating the dead with dignity and respect so that it may not bring more distress to the survivors.  At the time of disaster, there is a need for collaboration between WHO and other agencies for management of the dead after a disaster.

As per Morgan, O. W, et al. the future research should concentrate on developing different methods to store dead where cold storage is not available. There is a need to research on avoiding water contamination that occurs due to burial. The study should be conducted to develop the technique to identify dead where forensic support is unavailable. There is a need to develop cheaper and affordable forensic techniques. There is a need to formulate the protocol for retaining the information about dead or missing persons.

The future research should concentrate on developing the better response in case of emergency, delay in the emergency response increase the mortality and disability in the post-disaster conditions. The government should have collaboration with a neighbouring country and should have an emergency fund to migrate the population residing in the coastal area. There is the need to develop strong architectural engineering buildings that can withstand the earthquake and tsunami in the future. The buildings should have a strong foundation.

The environmentalists should research on re-establishing the disturbed ocean floor. There has been massive destruction of flora and faunae of the ocean as tsunami waves retreated it washed away some harmful chemicals from land into the ocean. These chemicals made the water poisonous to creatures living in the ocean. The coral reefs that have been destroyed by the inflow of water and dragging of waste from land, these contaminations should be cleaned up. The researchers should focus on cleaning of the rivers that has been contaminated by sewage and ocean water. Due to tsunami there has been the complete destruction of agricultural land. The normal pH of farmland should be restored by treating the land with neutralizers.

The more reliable and efficient sources of weather reporting should be established. The earlier alert about the disaster will prevent the destruction and mortality caused by the tsunami. There should be warning in the coastal area so residents can evacuate promptly before the tsunami hit the land. The satellite images should be more clear and productive; it would be more beneficial if these pictures extracted early at the beginning of the disaster. The public health surveillance should also account for missing and displaced. The relief phase should work on determining the missing and dead as soon as possible. As the psychological health of the survivor greatly depends on the information about their relatives whether dead or alive, it will reduce the future efforts in treating such psychological patients.

Conclusion

To work in a disaster situation is not an easy task. The persons that work during disaster recovery phase should take precautions. The people who handle dead bodies should wear gloves and wash their hands as they may come in contact with body fluids that might have an infection like HIV, tuberculosis, hepatitis that can be transmitted. Though till now no such cases has been reported but still occupational safety measures should be taken to avoid any future infection. They should be followed to see the long term incubation and development of any disease.

In the recovery phase, the priority must be given to improving the transportation by the construction of new roads, cleaning and repair of existing road. As due to tsunami the roads get blocked due to water and debris from trees and dead animals, mud and construction side wastes or broken parts of houses making the transportation and help from other agencies difficult to reach to these areas. The government should plan a more efficient way to transport through boats or helicopter to reach to the people and provide the basic survival needs.

In future, the government should develop a policy to develop more stable recovery phase during such disaster. The government should subsidise the family in the form of loans, new jobs, free education, shelter and food for those who lost the family member on which they were dependent for survival. Missing children should be reported to the authorities, and immediate action should be taken to restore the child to its family. There is the need to maintain the record of dead and missing persons. To mitigate the future lose the government should not permit the residency near the coastal areas that are in the danger zone if a tsunami hit in future. The early evacuation and intimation of the tsunami by weather forecast can prevent the deaths.

There is a need to alert the coastal area that has experienced tsunami destruction I past. The houses should be building high above the sea level, so that even if tsunami waves come in future would not be able to destroy the houses. Even a wall can be built to hinder the tsunami wave. The city planning should be down so that the hospitals should be located in the interior of the town and would not be affected by the future tsunami. The generators in the hospitals should be placed on the second or third floor so that even in an absence of electricity and flooding the hospital will not have to face any difficulty.

The disasters are continuously increasing; in future there is a need to concentrate the resources to lessen the effects of the catastrophe. The emergency preparedness should be ready to evacuate the population and provide the necessary health needs in a disaster situation. It is recommended that countries in disaster prone area should sign a pact deciding that in the case of emergency the help should be provided by their neighbouring country. During tsunami people often migrate from their residential area, the neighbouring states should collaborate with these people.

References:

  1. Leitmann, J. (2007). Cities and calamities: Learning from post-disaster response in indonesia. Journal of Urban Health, 84(3 Suppl), i144-53.
  2. Guha-Sapir D. (2007). Short communication: Patterns of chronic and acute diseases after natural disasters – A study from the international committee of the red cross field hospital in Banda Aceh after the 2004 Indian ocean tsunami. TM & IH. Tropical medicine and international health, 12(11): 1338-41.
  3. Souza, R., Bernatsky, S., Reyes, R., & de Jong, K. (2007). Mental health status of vulnerable tsunami-affected communities: A survey in aceh province, Indonesia. Journal of traumatic stress, 20(3), 263-9.
  4. Musa, R., Draman, S., Jeffrey, S., Jeffrey, I., Abdullah, N., Halim, N. A., … Sidi, H. (2014). Post tsunami psychological impact among survivors in aceh and west sumatra, indonesia. Comprehensive psychiatry, 55 Suppl 1, S13-6.
  5. de Pee, S., Moench Pfanner, R., Martini, E., Zlotkin, S. H., Darnton Hill, I., & Bloem, M. W. (2007). Home fortification in emergency response and transition programming: Experiences in aceh and nias, indonesia. Food and nutrition bulletin, 28(2), 189-97.
  6. Doocy, S., Gorokhovich, Y., Burnham, G., Balk, D., & Robinson, C. (2007). Tsunami mortality estimates and vulnerability mapping in aceh, indonesia. American Journal of Public Health, 97 Suppl 1, S146-51.
  7. Srinivas, H., Nakagawa, Y. (2008). Environmental implications for disaster preparedness: Lessons learnt from the indian ocean tsunami. Journal of environmental management, 89(1), 4-13.
  8. Morgan, O. W., Sribanditmongkol, P., Perera, C., Sulasmi, Y., Van Alphen, D., & Sondorp, E. (2006). Mass fatality management following the south asian tsunami disaster: Case studies in thailand, indonesia, and sri lanka. PLoS Medicine, 3(6), e195.

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Vidushi Prasad – Epidemiologist, Master in Public Health (MPH), Texas A&M University, USA. Dental Surgeon (B.D.S.), DMIMS, India


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This article originally appeared on Transcend Media Service (TMS) on 6 Apr 2020.

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