Philippe Guérin, Scientific Director of Epicentre - the epidemiology branch of MSF - explains that natural disasters do not harbour epidemics. He details the risks and priorities in the wake of the Kashmir earthquake, as he had done after the tsunami that struck southern Asia in December 2004.
In medical terms what are the consequences of a natural disaster such as the earthquake in Kashmir?
The immediate impact of a natural disaster is the huge number of victims. The dead, of course, but also the injured, who have to be treated as quickly as possible. People are suffering from cuts and fractures and, if there is no treatment, their wounds quickly become infected in the difficult conditions.
In the specific case of an earthquake, people can also suffer from a crush syndrome. This happens when they have been caught under collapsed building during several hours, their muscles enduring high pressure, which leads to dysfunctions of their kidneys.
And then, the earthquake has destroyed houses and infrastructures, in particular drinking water supply systems (wells, pipes etc.). The destruction of homes often means that populations are being displaced and forced to regroup themselves in very makeshift conditions. This is the biggest risk in health terms: forced overcrowding, insufficient access to drinking water and medical treatment, and, in a near future, food.
These circumstances can result in diseases and encourage the spread of common infectious diseases. Sleeping outdoors and in makeshift shelters, people can contract respiratory infections, especially children. After the earthquakes in Afghanistan in the late 90s, or in Bam (Iran) in December 2003, the vast majority of MSF consultations involved respiratory infections.
This is particularly true in the high altitude region of Kashmir, where weather conditions are bad. Within two weeks, winter will begin with the first snows. There is also a risk of diarrhea-related diseases as a result of consumption of contaminated water. In Pakistan, shigellosis (a dysenteric disease) can be a specific problem.
But it is untrue to think that a natural disaster itself leads to a wave of epidemics. Our experience with natural disasters proves that they do not lead systematically to epidemics. Once more, after the tsunami in South Asia, doom-mongers predicted massive epidemics. But once more, nothing of the sort happened.
The media is focusing on the problem of bodies that have not yet been buried or burnt. But, here again, bodies themselves are not vector of spreading diseases. For the survivors, the priority in public health terms is access to decent shelters, drinking water and medical treatment. Of course, bodies have to be collected, but that is more for psychological reasons in these circumstances.
Corpses do not have an epidemic potential in this type of situation.
On the other hand, in the case of certain specific pathologies like cholera or malaria, they already have to exist in the countries concerned for there to be a risk of an epidemic.
In Kashmir, a mountainous zone, there is no malaria. As for cholera, since it is present in the region, a close surveillance system has to be put in place in order to monitor the outbreak of isolated cases. Then we need to be ready to react so that we can treat the sick and endeavor to stop the spread of disease. Measles cases will also have to be kept under watch, as the vaccination coverage is probably low in this region.
But, once again, these risks of epidemics are not directly linked to the earthquake, as experience and scientific literature demonstrate. Isolated outbreaks may happen, but they result rather from the poor living conditions in destroyed areas. Epidemiological surveillance and medical treatment should prevent them from degenerating in widespread epidemics.
What is the role of a humanitarian medical organization such as MSF in a catastrophe such as this one?
First of all, assessing the needs on a case-by-case basis. The situations vary significantly from village to village, according to the level of destruction and number of the injured. The already fragile health systems will likely be temporarily submerged by the influx of injured. Furthermore, within any country, there are always segments of the population that are neglected by the aid agencies and these are the ones on whom we try to focus our efforts.
We may be asked to intervene in various ways. Sometimes we can help to take care of the injured, where there is a need for this. But caring for the injured is an emergency in the first few days and NGOs often arrive too late for that. The wounded are mostly taken care of by local doctors sent from unaffected zones of the country hit by a disaster.
So the main part of our action will be to ensure access to treatment, emergency distributions of shelters and blankets, and water supplies for the populations affected by the disaster. In the short term, this should lead to an improvement in their living conditions and limit the mortality rate in the event of the appearance and spread of diseases. Finally, we can participate in the epidemiological surveillance effort.