Angus Cook and Phil Weinstein at the University of Western Australia, Crawley, consider the long term care needed by communities struck by earthquakes and other natural disasters.

We often only think of natural disasters as sudden and short-lived upheavals in normal life.  After dramatic events such as earthquakes, floods and hurricanes, it is often the immediate needs that capture most of the attention and resources. The long-term health needs of communities in this situation are normally overlooked.  Recovery from natural disasters may in fact be a drawn-out, unpredictable process. Human health problems after major disasters range from psychological disorders - including depression, anxiety and substance use - to physical injury and illness. These illnesses may appear across the community, including those who have lost property, belongings or the capacity to sustain a livelihood - or even the more general population living outside the disaster zone who may be affected in indirect ways. One obvious delayed impact is malnutrition from the disaster event either compromising the quality of food available - such as crop yields and fish stocks - or impeding ready access to supplies. Populations already vulnerable to poverty and food insecurity, such as those living in sub-Saharan Africa, are particularly likely to succumb to a superimposed crisis. After the 2005 Pakistan earthquake, 2.3 million people experienced problems with food supplies for many months because of logistical difficulties in providing relief and the inaccessibility of affected areas.

Large scale destruction of homes may force populations into camp accommodation for years

Natural disasters are often linked to outbreaks of infectious disease, and most occur around the time of the emergency. However, people who are displaced for longer times after the disaster are at risk from poor sanitation, overcrowding and contaminated food and water. Large scale destruction of homes may force populations to remain in camp accommodation for years. After the Mount Pinatubo eruption in the Philippines, 18 000 cases of measles struck those living in camps. Disruptions of water systems provides ideal conditions for breeding mosquitoes and the eventual spread of the diseases they carry. Heavy rains and flooding appeared to be responsible for increased dengue rates in Thailand, Indonesia, Venezuela and Brazil, and for the re-emergence of West Nile Fever in Romania in 1996, the Czech Republic in 1997 and Italy in 1998.

The increased strain on existing medical facilities after emergencies may destabilise normal patterns of care. This leads to illness for those who require medications, ongoing procedures (such as dialysis), or a high level of care (including the elderly, and those with long-term illnesses or disabilities). Many disasters spread toxic agents - including biological and chemical wastes - into the environment, and diseases from such hazards may not be apparent until years after the event. Considerable concern has been expressed about the potential toxicity of the floodwaters in post-Katrina New Orleans, which left sediments rich in heavy metals, petrochemicals and asbestos. 

Mental health issues following natural disasters are well documented, and it is common for victims to experience distress after such overwhelming events. Many people experience ongoing mental illness, including post-traumatic stress disorders. Research suggests that this is not necessarily short-lived, and may persist for a decade or more in a third of the initial cases. Depression, suicide and child abuse are other delayed consequences of disasters. The social and economic impacts of disasters in shaping long-term health should not be underestimated, and post-event unemployment is strongly associated with mental illness. Many families suffer considerable financial hardship and may become temporarily or permanently relocated, thereby interrupting established community, cultural and social ties.

Disaster relief remains largely crisis dominated. Many emergency organisations do not have adequate processes or the authority structure to assess risks and health needs in the weeks, months and years following a disaster. As we may be moving into an era of climate change and extreme weather events, it is timely to note that recovery from disasters is protracted and not inevitable. With mounting evidence of ongoing health problems, health services must extend their horizons of care and need to anticipate increases in demand beyond the immediate emergency.  

Read Angus Cook's critical review '10th Anniversary Review: Natural disasters and their long-term impacts on the health of communities' in issue 2, 2008 of  Journal of Environmental Monitoring.