As typhoon Haiyan’s gale-force winds accelerated to 170 mph and churned the waters of the Pacific Ocean on Friday, 20-foot storm surges bit into the Philippines’ eastern shores like a hungry sea creature, devouring everything in its path, including villages, buildings, and residents in six of the archipelago’s central islands.
Sated, Haiyan, is only now spitting back what she stole. In the coastal town of Tacloban, the city worst hit by the record-breaking typhoon, mothers, fathers, sisters and brothers consumed by the storm are washing ashore. Bloated by the salt water, they may remain under the hot and humid sun for days. Without electricity to properly store the bodies, or body bags to collect them, emergency crews have nowhere to collect the rapidly growing victims of storm, which now number 10,000.
The corpses, however, are the least of the Philippines’ public health challenges. Despite public perceptions to the contrary, Thomas Kirsch, director of the center for refugee and disaster response at the Johns Hopkins Bloomberg School of Public Health, says bodies aren’t a considerable source of disease following natural disasters like typhoons. “They are only a source of infection if they already had an infectious disease such as cholera in their bodies,” he says.
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More worrisome for public health are the disruptions in water, sanitation and sewage services, since these can contribute to contaminated water and environments that promote the spread of diarrheal diseases. And in conditions where water is scarce, these diarrheal conditions can be even more deadly, since they can lead to dehydration and even death.
“When you have salt water storm surges, it makes all the wells salty. So it sounds trivial, but the most annoying and disturbing thing for a lot of people is that their water supplies will have had salt water seep down into them and won’t be drinkable in the time when they need it the most,” says Les Roberts, acting director of the program on forced migration and health at the Columbia University Mailman School of Public Health. Flushing out the salt water could take weeks, if not months of rains.
Outbreaks of infectious diseases can occur 10 days to a month after a natural disaster, and displaced residents who are evacuated to crowded shelters also encourage the spread of disease, as limited resources and close quarters make transmission of bacteria and viruses responsible for colds, flu and pneumonia more likely. Still, according to the World Health Organization (WHO), no serious epidemics have emerged following natural disasters in recent years.
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But the typhoon may pose unique problems for controlling certain illnesses. The rainfall from the storm surge, for example, has left pools of standing water — puddles or ponds that now become breeding grounds for mosquitoes that can spread malaria. And with little or no health care services available, many of these infections may go untreated and lead to more death in coming months.
“You have an increased number of patients, and a lot fewer facilities in which to treat them,” says Kirsch, who has been part of relief efforts following Hurricane Katrina and Superstorm Sandy in the U.S., and is helping to rebuild public health capacities in the Philippines. The immediate health care needs can extend for a week or more, he says, as the injured are found and treated.
Very soon, however, the Philippines will need to restore more routine emergency health services, for those involved in traffic accidents, women having babies, or patients with serious infections. Finally, the government will have to rebuild the infrastructure of health care services that were wiped out by the typhoon – including hospitals and clinic, as well as the doctors and nurses that provided the care, many of whom perished in the storm.
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And looking even further ahead, Roberts says the nation could learn valuable lessons from countries like Bangladesh and those in the Caribbean, which took steps to minimize the public health toll of natural disasters that are common in those regions. To a certain extent, no government can fully prepare for a storm of Haiyan’s magnitude, but by placing stores of medical supplies and clean water in high and dry locations that can be transported to low-lying coastal areas can help to reduce the risk of dehydration and illness from compromised water and sanitation systems. Educating and alerting citizens to emergency messaging systems can also save lives; in Bangladesh, concrete storm shelters and a siren system had reduced deaths from typhoons and tsunamis by 90% from the 1970s to the 1990s, with very little change in building codes or zoning regulations for coastal structures. “It’s astonishing what good preparedness can do,” says Roberts.
In the meantime, he anticipates that some of the most fundamental needs of the hardest hit citizens – for food, water and shelter — will come not from humanitarian aid from abroad – although that is welcome and desperately needed — but from their own countrymen. With logistical bottlenecks already stymying relief efforts – the nearest airport is in shambles, and bridges and roads have been destroyed, “simple acts by Filipinos aiding Filipinos by sharing their food and coming up with creating ways of getting food, water and shelter to where they need to be, will solve many problems,” he says.
To help rebuild medical services, WHO shipped four emergency kits with enough medical supplies and medications to treat 120,000 people for one month, and equipment to perform 400 surgeries if needed, to repair broken bones or other traumatic injuries. Other drugs to treat diarrheal diseases are also part of the organization’s initial relief shipment.