Lazar Beinin. Medical. Consequences of. Natural Disasters. With 45 Figures and 40 Tables. Springer Verlag Berlin Heidelberg New York Tokyo

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2 Lazar Beinin Medical Consequences of Natural Disasters With 45 Figures and 40 Tables Springer Verlag Berlin Heidelberg New York Tokyo

3 Dr. med. Lazar Beinin Rehov Hamorad 8/ Nazareth/illt, Israel ISBN-13: e-isbn-13: DOI: / Library of Congress Cataloging in Publication Data. Beinin, L. (Lazar), Medical consequences of natural disasters. Bibliography: p. 1. Natural disasters Hygienic aspects. 2. Emergency medical services. 3. Disaster relief. 4. Disaster medicine. I. Title. [DNLM: 1. Disaster Planning. 2. Disasters. 3. Emergencies. 4. Emergency Medical Services. WB 105 B422m] RA645.9.B ' This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocoping machine or similar means, and storage in data banks. Under 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to "Verwertungsgesellschaft Wort", Munich. Springer-Verlag Berlin Heidelberg 1985 The use of general descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2119/

4 For my wife Polina

5 Preface In spite of all the progress made by modern science and technology in penetrating the mysteries of nature and providing new possibilities for its transformation, we remain largely helpless in the face of such natural phenomena as earthquakes, tsunami, typhoons, floods, and droughts. Natural disasters occur suddenly, but with periodicity, and man has been confronted by their devastating consequences throughout history. The way people deal with these problems is primarily predetermined: by character, by conditions, and by the social and economic development of society. Industrious efforts to reconstruct nature, and exploitation of her resources, have brought about additional damage, and there is the apparent danger that our interference with the atmosphere and other areas such as climate, soil, and hydrology has initiated devastating processes which may well be irreversible. As a result, the effects of natural disasters, and all the ensuing repercussions, become ever more aggravating. Their scope becomes global, and for the time being we have no effective countermeasures at our disposal with which to fight them. The contemporary world, then, faces the interconnected and interdependent phenomena of ecological crises and natural disasters: the problem of protecting man from the environment, and the concurrent problem of protecting the environment from man. We are concerned here with medical ecology, which is obviously ethically grounded, in its study and analysis of modern life. An important example is the intensive development of transport capacities, accompanied by massive road traffic catastrophes involving deaths and injuries - for natural disasters are determined both by natural factors and by man's activities. The devastation that follows directly affects the environment, people's health and way of life, and the economy. In the ensuing emergency situation - after man has fallen from the heights of civilization created by his own genius - there is a desperate need for highly effective health services and social stability. The readiness of the public health services and the responsiveness of a society under stress are tested to the limits. Sanitary, hygienic, and everyday domestic conditions are intensified to the point of bursting by epidemic processes. Frequently, information is abnormally received and interpreted. Injured people and those around them tend to become demoralized. One of the problems is a rise in crime, and the danger of anarchy and its accompanying phenomena is especially acute. VII

6 People accustomed to the amenities of contemporary life suffer greatly when deprived. of them by natural disasters. The suffering is especially unbearable when several natural disasters strike a region simultaneously, leaving the population helplessly facing new and extreme conditions. Disasters frequently take on cataclysmic proportions. The regular rhythm of life is paralyzed. An area cannot solve its problems without outside assistance, owing to a discrepancy between the medical needs of the injured and the objective capabilities of the local medical services. There is enough evidence testifying to the readiness of other countries to provide necessary help. However, practical deployment of resources based on a rationally elaborated plan must include: a) the organization of emergency teams especially for this purpose, equipped to provide medical and other aid, and the determination of their operational activities, and b) assessment of the requirements for and the delivery and distribution of food, clothing and medicine, and temporary accommodation for those made homeless. In a sense, the organization of emergency measures under disaster conditions and the ability to cope with the problems arising, including jeopardized public health and safety, may serve as an index of a country's social and economic foundations and of its civil defense preparedness. Experience in fighting natural disasters has shown an almost universal lack of preparedness in providing effective, wellorganized help to the injured and the stricken area. Many lives are lost, health is endangered, and material damages are huge. Nonetheless, the tendency to remain inactive, to prefer risk to preventive measures (which require considerable expenditure and are therefore generally unpopular) appears to prevail at all levels of decision-making. Preventive measures are here understood as actions relevant to the long term, and preference is given to solving problems which appear more immediate. Consequently, there is a tendency to postpone preliminary elaboration and implementation of the following aspects of an interconnected and interrelated relief system: 1. Complex preventive and defensive measures must be implemented in handling the effects of ecological crisis, earthquakes, tsunami, and droughts. Anthropogenic disasters such as road traffic catastrophes must also be taken into account 2. Help must reach the focus of the disaster in the shortest possible time, rescue operations must be launched immediately, and medical and other aid must be provided 3. Comprehensive information on the scope and intensity of the disaster must be collected and processed, and the activities of the various health authorities responsible for ameliorating the situation must be coordinated This volume addresses the following medical consequences of natural disasters: 1. Effects on public health and safety 2. Peculiarities of the emergency situation; the main natural and other factors predetermining the organization of medical aid and the evacuation of the homeless VIII

7 3. Provisions for public health and safety in the event of disaster, and sanitation of the environment Known natural disasters are investigated, with emphasis placed on the natural, socioeconomic, and other factors affecting the areas and the populations stricken. Among others, the following events are discussed: 1. Earthquakes in Japan (1923), the Crimea (1927), Tajikistan (1930), Armenia (1934), Moldavia Soviet Socialist Republic (1940), Ashkhabad (1948), Tashkent (1966), and Guatemala (1976) 2. Tsunami in Japan (1896), Italy (1908), the Hawaiian Islands (1946), the USSR (1952, 1960), Chile (1960), and Bangladesh and India (1970) 3. Floods in the USSR (1914, 1924, 1964, 1966, 1969) 4. Mudflows and snowslides in the USSR (1921, 1963, 1967), England (1966), and Peru (1970) 5. Mass hunger in the USSR ( ), Leningrad under blockade ( ) and western Africa (1973) 6. Road traffic catastrophes in Israel Analysis of the ensuing injuries and of infectious and general diseases is based mainly on documentary data of the USSR public health authorities and on the literature from other countries.. The material and its analysis are treated here in light of my personal experience in combating and taking preventive measures against the public health consequences of natural disasters (Moldavia, 1940; Kamchatka, 1957, 1960). Special trips made to stricken areas - Greece, Italy, Russia, the Ukraine, and the United States - facilitated deeper understanding of the situations and, to a certain extent, concrete evaluation of future prospects. Experience in the field of health services as organized in Central Asia and my military experience in World War II have been used as well. Drawing, then, on more that four decades of firsthand experience of natural disasters in many different countries, I find that some general observations can be made. For example, it is not only that the danger is often underestimated. Frequently, socioeconomic, political, and administrative difficulties obstruct mobilization of the considerable resources needed for efficient prophylaxis and protection, even though, objectively speaking, all the necessary material and technology are at the disposal of those responsible for dealing with these problems. Obviously, natural disasters cannot be prevented. However, damage and lives lost can be kept to a minimum through a proper application by man of his knowledge and technology. I hope that the present study will help to further this end. Nazareth, May 1985 L. Beinin IX

8 Contents A Brief Historical Review of Natural Disasters 1 Public Health Consequences of Earthquakes 12 Public Health Consequences of Tsunami 28 Public Health Consequences of Floods. 45 Public Health Consequences of Mudflows and Snow Avalanches 61 Public Health Consequences of Mass Hunger Public Health Consequences of Road Traffic Catastrophes 81 Factors Predetermining the Method of Eliminating the Public Health Consequences of Natural Disasters Medical Provision in the Initial Phase of a Natural Disaster Medical Provision During Evacuation After a Natural Disaster. 116 Public Health Care, Aid and Protection of the Population in Connection with Natural Disasters. 126 Conclusion. 146 References. 149 XI