EH Measures for Disease Control After Emergencies

8/13/2019 EH Measures for Disease Control After Emergencies

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A mother and child heading

for a place, through 'nose-

deep' flood water in

Birshing village, south west

of Guwahati, on July 14.


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Top 10 most important disaster by

number of killed in 2007

Event Country People KilledCyclone Sidar,November

Bangladesh 4234

Flood, July – August Bangladesh !

Flood, July"Se#tember $ndia !3Flood, August %orea &em' (' )e# *!

+eat ave, July South -uro#e and theBal.ans

/*0

Flood, June – July China (' )e#' /3/

-arth1ua.e, August (eru /Cyclone emyin, June (a.isthan 242

Flood and andslides,June

(a.isthan 225

Flood, July $ndia 22/

6otal 303Source:Annual Disaster Statistical review,CRED,Belgium


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Impact

Two illion people !ace "ealt" t"reatsecause t"ey are at ris# o! or e$posed tocrisis condition

Twenty million people or %& countries areactually in crisis Si$ty 'ive percentage ()%*+ o! Epidemic

reported worldwide occur in comple$

Emergencies


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Impact: A Larger Picture

-uman lives

.ivestoc#, ot"er animals

Private property

/unicipal in!rastructure Power0

telecommunicationsin!rastructure

-ealt"0 education assets

1u2arat eart"3ua#eestimate:

4S5 6789 /illion

&irect losses

E$port0 import

Agricultural output

ndustry0 services output

Remittance income

'all in earning potential(due to disaility, traumaetc+

4nemployment

-ealt" "a;ards

1u2arat eart"3ua#eestimate:4S5 )6% /illion

$ndirect losses

.ong


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Mortality due to natural a!ards in

India

Name o7

Country

&eaths caused by natural

disasters

Natural disasters mortality

ratio 8#er !!,!!! deaths9

ndia7997<

799%

799)<

>&&&

>&&7<

>&&%

>&&) 7997<

799%

799)<

>&&&

>&&7<

>&&%

>&&)

>&,?>? >8,)&% @887@ )98 @? )6 7&6 ?

Source: ESCAP Statistical earoo# !or Asia and t"e Paci!ic >&&?:

"ttp:00wwwunescaporg0stat0data0sy>&&?0


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"amaged caused by Mass casualty

#$ents due to %atural "isasters in India

ear Peoplea!!ected

( .a#"+

-ouses uildings,partially or

totallydamaged

Amount o!propertydamage0los

s (Rs Crore+

7998 %>7? 7%)6@&% &?>

7999 %&7? 67&@&)@ 7&>&9?

>&&& %9@6@ >?6)6%% 8&&&&

>&&7 ?8879 8@)8?8 7>&&&


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List of %atural "isasters (Recent Past)

&isaster (lace

Cyclone, 799?, 7999 1u2arat, =rissa

'lood, >&&&, >&&@,

>&&%,>&&?,>&&8

Assam Bi"ar B 1u2arat

=rissa 4ttaranc"al Tamiladu /a"aras"tra

Eart"3ua#e, 799? 7999>&&7>&&@ >&&%

/a"aras"tra /P 4P 1u2aratAndaman icoar FK

.andslide, >&&@ Kas"mir S"imla, ort"east

region

Tsunami, >&&@ Sout" ndia

-eat ave, >&&@ Del"i, -aryana, 4P, Pun2a


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&ealt Issues after a "isaster

A##ro#riate handling o7 the dead $n:ury and disability (sychosocial #roblems ;ater and -nvironmental sanitation Communicable &isease )e#roductive and child health issues Sustaining .ey health care delivery

7unctions, including medicines and critical

medical su##lies $mmuni


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#n$ironment &ealtManagement

During Emergencies


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#ffects of "isaster on 'eneral

#n$ironment ( )anitation

Contamination o! drin#ing water Contamination o! !ood .oss o! general immunity Breeding and increased density o! insects and

rodents Breeding o! vectors Spread o! water orne diseases ie c"olera,

enteric !ever

Spread o! vector orne diseases ie malaria,dengue Spread o! uncommon ;oonotic diseases due to

ecological disturances ie plague, leptospirosis


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Priority #n$ironmental &ealt )er$ices

Ade3uate amount o! sa!e drin#ing water Disposal o! "uman e$creta Disposal o! waste water and solid waste Ade3uate s"elter 'ood protection measures Gector control measures Promoting personal "ygiene and EC Disposal o! dead odies


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#n$ironmental &ealt and Priorities for

inter$ention in Emergencies

To recognise

To understand

To understand

To design

To descrie To identi!y

t"e environmental "ealt" ris# !actors

and constraints o! environmental

"ealt" management t"e asis !unction o! a sanitation

programme t"e value o! various water sources and

minimum standards !or water 3uality

and 3uantity a simple environmental "ealt"

programme diarr"oeal outrea# control strategies #ey indicators !or monitoring

environmental "ealt" programmes


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• Water stagnation

• Blockage of drains

• Inadequate H.P.• Water quality/availability• Irregular tank filling

• Lack of Ventilation• Inadequate Bathroo• !vercro"ding

• #olid "aste dis$osal.• %ly & osquito nuisance

• %ish "aste• 'ry fish sell

• 'efecation near the shelters.

• Inadequate sanitary facilities

• Poor use/ aintenance

Problems identified after te rapid en$ironmental

need assessment in Tsunami affected areas


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4se .ocally availale trained manpower asEnvironmental -ealt" Specialist are not

always availale Restore Pre


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)afe "rinking *ater)upply


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"iseases related to drinking +ater

contaminated +it micro,organisms

Diarr"oeaH

Typ"oidH

-epatitisH

C"oleraH

( Contaminated water is not the only cause of these diseases water

!uantity, poor sanitation and poor hygiene practices also play a role


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'eneral Principles of #mergency

*ater Management

All People s"ould "ave access to su!!icient 3uantity o! water!or drin#ing, coo#ing and personal and domestic "ygiene

At least 7% liters o! water per person per day need to ecollected

T"ere is at least 7 water point per >%& people 'low at eac" water collection point is at least &7>% liters per

second

T"e ma$imum distance !rom any s"elter to t"e nearest waterpoint is %&& meters


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'eneral Principles of #mergency *ater

Management cont-

Ensure 3uality o! water to reduce t"e transmission o!disease

Evaluate potaility o! potential water sources y rapidsurvey

Assess t"e iological ris#s associated wit" water Determine t"e pattern o! sur!ace drainage, pro$imity to

local sewage system and potential !or c"emicalcontamination

Rapidity to convert a source into sa!e one is very important

Rapid environmental "ealt" remedies: repair o! sewagelines0parapet o! a well

! no local sources availale, resort to water distriutionsystem


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.ecklist for *AT#/ )A#T measures at ield

le$el

At t"esource

ater !or drin#ing need to e collected !rom

t"e cleanest possile source

! necessary, a distinction is made etween

water !or drin#ing and water !or ot"er uses,suc" as at"ing, laundry, watering animals

ater sources need to e protected !rom

!aecal contamination y !encing (to #eep

animals away+, and y sitting latrines or

de!ecation !ields at least 7& I away,depending on ground conditions


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Collection,

storage and

use o7 aterat household

level

=se o7

ater

ater is collected and stored in clean,

covered containers

ater is ta#en !rom t"e storage container

wit" a clean, long


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Metods of making "rinking +ater )afe

Straining> ncase "eavy sediment or !loating matter present watermust e strained t"roug" several layers o! clean clot"es e!ore!urt"er processing+

&isin7ection>

Solar &isin7ection>

&isin7ection by Boiling > Boiling vigorously !or 7& minutesma#es water sa!e !rom "arm!ul acterial contamination ut it isvery di!!icult to searc" !uel !or oiling immediately a!ter adisaster

&isin7ection using Chlorine > C"lorination, t"e most commonmet"od in emergency

Disinfection should not be used as a substitute for protecting water sourcesfrom contamination.


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"omestic .lorination of "rinking *ater

Crus" commercially availale c"lorine& litres o! water

Allow to stand !or 6& minutes

4se water wit"in >@ "ours

Containers with a narrow mouth are recommended for the storage of

drinking water


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.lorination .ecklist

T"e optimum c"lorine residual in a small, communal water supply is

in t"e range o! &6 to &% mg0l

C"lorine needs at least "al! an "our contact time wit" water to

disin!ect it ever add any solid !orm o! c"lorine directly to a water supply, as it

will not mi$ and dissolve Always ma#e up as a paste !irst, mi$ing

t"e c"lorine compound wit" a little water

Disin!ection is only one de!ense against disease Every e!!ort

s"ould e made to protect water sources !rom contamination, andto prevent suse3uent contamination during collection and storage

T"e c"lorine dose re3uired to disin!ect a supply will increase i! t"e

water is very turid n suc" circumstances, it is est to treat t"e

water to reduce turidity e!ore c"lorination


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Pro$ision of )afe *ater )upply

Drin#ing water sac"ets may e

provided during initial p"ase

later water may e provided y

water tan#ers

Temporary small water tan#s

may e provided in t"e camps

Ade3uate c"lorination o! water

ensured y t"e "ealt" wor#ers

ater Juality /onitoring done

y testing !or residual c"lorine

and microiological testing o!

samples


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Tree .ommon Tests

'ield < ->S Test

.a< /ultiple < Tue 'ermentation Test (/P met"od

!or coli!orm acteria+

=T Test


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.ocation o! stand postover"ead tan#s

/et"od o! testingp"ysical, c"emical and

acteriological c"aracteristics

Periodicity o! testing

Resultsc"lorine level

Distriution area /ode o! distriution=-T, =-T and

pipes, lorries, R= system

Jualitydate o! testing

TDS

Bacteriological content Remedial actionc"lorination

"et"er end


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)afe "isposal of &uman#creta

A . kli t f A ti t i ld


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A .ecklists for Action at ield

Le$el

#3./#TA "I)P4)AL

4se o!designatedplaces !orde!ecation

Actions ta.en

De!ecation is avoided near water sources and

water


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A .ecklists for Action at ield

Le$el

#3./#TA "I)P4)AL(contd.)

C"ildrenMssanitation

Actions ta.en 4ncontrolled de!ecation y c"ildren is stopped

(T"e !eces o! young c"ildren are more "arm!ult"an t"ose o! adults+

T"e stools o! young c"ildren or aies are

wrapped in leaves or paper and uried or put in a

latrine

oung c"ildren are "elped to de!ecate into an

easily


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)ome Tips for safe )anitation issues

"uring "isaster

Sanitation Temporary latrines s"ould e constructed .ime to e used in communal trenc"es Area to e #ept clean aste water !rom t"e area to e properly drained

out

Sa7e distance o7 atrines ) metres !rom dwellings 6& metres !rom community well S"ould not e located at "ig"er level t"an

drin#ing water source S"ould not touc" t"e water tale


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)anitary Toilets

Development o! t"ree designso! t"e community level toiletsand inculcate t"e "ait o! usingt"em

ncineratora way to promotetoilet "aits among women anddisposal o! sanitary nap#ins

Development o! ay


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)trategies to .ontrol &uman #creta

"isposal at "isaster sites

Designate speci!ic areas !orde!ecation

Protect latrines !rom sur!acewater drainage

Consider cultural !actors inlatrine design (eg, need !orprivacy+

Educate t"e population

Ensure proper latrine

maintenance 'acilitate t"e population)s

access to latrines

-and as"ing wit" soap


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Maintaining a )anitation )ystem for

&uman #creta

Populations are unli#ely to use latrines o! t"ese are not#ept clean

/ay re3uire contracting out * t"e cleanliness service

Regular addition o! soil, diesel or as" to t"e latrines

Ade3uate source o! lig"ting !or nig"t use

Proper ad2ustment in si;e to !acilitate t"e use y c"ildren

Periodic inspection y "ealt" aut"orities is essential

Relie! agencies01=s may provide tec"nical assistance int"e !orm o! sanitarians !or construction, maintenance !orsupply o! dis


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Personal &ygiene and I#.


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A .ecklists for Action at ield Le$el

PERSONAL HYGIENE

ater !orwas"ing

Actions ta.en

! possile, plenty o! water is used!or was"ing

Clot"ing is laundered regularly T"e most readily availale water is

used !or personal and domestic"ygiene


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PERSONAL HYGIENE

-and<was"ing

Actions ta.en

All !amily memers was" t"eir "andsregularly: a!ter de!ecating a!tercleaning a c"ild w"o "as de!ecatedand disposing o! t"e stool e!orepreparing !ood e!ore eatinge!ore !eeding a c"ild

Adults or older c"ildren was" t"e"ands o! young c"ildren


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)ome Tips .oncerning Personal &ygiene

"uring "isaster

(ersonal +ygiene

-and was"ing, cleaning and at"ing !acilities

Ade3uate water supply

Avoid overcrowding in sleeping area

.aunc" education campaign on personal "ygiene

I f i #d i d


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Information5 #ducation and

.ommunication

Based on t"e rapid environmental

assessment, target


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Information5 #ducation and

.ommunication cont-

As in sanitation, local pro!essionals are t"e people

w"o are est suited to develop and deliver

"ygiene education

Educational messages s"ould e s"ort and!ocused

T"e s"ould also !ocus on e"aviors t"at are not

eing practiced y a signi!icant !raction o! t"e

population


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)olid *aste and *aste *ater

"isposal


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on )olid +aste "I)P4)AL

Solid aste

Actions ta.en

Re!use is not to e scattered aout (T"isencourages insect reeding and attracts rats

w"ic" can e a nuisance and transmit disease+

n t"e immediate post


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on )olid +aste "I)P4)AL

Solid aste management

Sanitary disposal o! re!use to control vector<

orne diseases Burying or urning is recommended

Carcasses waiting urial s"ould e sprin#led wit"#erosene


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)olid *aste Management A continuous "ealt" education

programme need to e conducted onsolid waste management and t"eimportance o! vector control

"erever necessary, t"e stagnated

solid waste needs to e removedwit" t"e "elp o! local 1=s,community volunteers and sanitarywor#ers

A system in coordination wit" t"e

"ealt" aut"ority, sanitary wor#ers,1=s and community volunteers tomaintain solid wastage disposal ycollection, segregation andtransportation !rom t"e s"elterareas, need to e developed


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*ater "isposal Li6uid *aste


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on WASTE DISPOSAL

Disposal.i3uidaste

Actions ta.en

Standing pools o! polluted wastewater (!romwas"ing, !ood preparation, wasted tapwater+ are not to e allowed to !orm (T"eyencourage mos3uito reeding, w"ic" is a"ealt" "a;ard+

C"ildren need to e prevented !rom playingin or near "a;ardous pools o! water

Arrangements !or disposing o! li3uid waste,

suc" as using soa#age pits, are understoodand !ollowed


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*aste+ater Management

Community moili;ation andeducation y sanitarianst"roug" demonstrations o!water disposal systems

n s"elters and villages, t"edrainage system need to eimproved scienti!ically incollaoration wit" t"e local1=s and governmentaut"orities

o stagnation o! waste water o water accumulation around

"andpumps,wells orstandpoints


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ector .ontrol

A . kli f A i i ld L l


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VECTOR CONTROL

Personalprotectionagainstdiseasevectors

Actions ta.en -ouse"old re!use is removed regularly to avoid

uild


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)ome Tips .oncerning Management for

arious #& Issues "uring "isaster

?ector Control

Resume collection and sanitary

disposal o! waste

Conduct pulic education campaign

Survey potential mos3uito, rodentand ot"er vector reeding sites

Eliminate vector reeding sites

Resume indoor and outdoor spraying

Store !ood in enclosed and protected

area Keep watc" on environmental

sanitation and personal "ygiene


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ector .ontrol

Breeding places identi!ied and

control measures

Training programme organi;ed !or

t"e local community and 1=s !or

vector control in t"e s"elters Training t"roug" demonstration in

t"eir dwelling places would

motivate t"e community to aim !or

!ly

s"elters

Activities suc" as application o!

c"emicals, spraying, oil alls, sand

!illing and levelling activities wit"

community participation


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ector control measures

N 'ogging

N nsecticide spray

N Anti


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#stablis .ommunicable "isease

)ur$eillance

/ost important to get reliale in!ormation, avoidrumours

Reliale in!ormation reassures pulic aout t"e

disease incidence Surveillance to e led y one agency

S"ould e lin#ed wit" response mec"anism

Availaility o! consensus national tec"nical

guidelines


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)elter


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/elief camp

NCamp cleanliness

N'ood availaility

Nater and Toiletsprovided

.onsiderations for setting up


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.onsiderations for setting up

)elters

.ocation: close to road, drainage good /aintain !amily0clan identity Special consideration to t"e needs o! elderly disaled /onitor y Pulic -ealt" Surveillance

Determine t"e source o! sa!e waters Ensure sa!e disposal o! "uman e$creta /inimi;e overcrowding Proper drainage system

Pysical Issues Associated +it


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Pysical Issues Associated +it

)elter Management

Provision o! roo! I plastic s"ed Tents0Pre

metre o! temporary s"edding 1round s"eets0lan#ets0source o! "eating or cooling

A . kli t f A ti t i ld L l


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SHELTER

At t"edisastersite

Actions ta.en

"ere people are trying to "ouset"emselves in t"e ruins o! t"eirprevious "omes, t"ey ta#e steps toavoid ris#s !rom t"e lac# o!structural integrity o! t"eir uildings

! t"eir "omes are de!initely unsa!e,people move

A .ecklists for Action at ield Le el


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SHELTER

n longer<termemergency

settlements

Actions ta.en

People ta#e part in residentsMcommittees to voice t"eir viewsaout t"e setting up and running o! a

camp Residents participate in cleaning t"e

settlement

C"ildren do not enter dangerous

areas o! t"e settlement and, i!necessary, volunteers guard unsa!eareas


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ood )afety



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arious #& Issues "uring "isaster

Food Sa7ety

Kitc"en sanitation I most important 4tensils cleaned daily

Personal "ygiene maintained

'ood storage I precautions against rodents and

insects


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/ules for )afe ood Preparation

Coo# raw !oods t"oroug"ly

Eat coo#ed !oods immediately

Store coo#ed !oods care!ully

Re"eat coo#ed !oods t"oroug"ly As !ar as possile provide "ot !ood

Avoid contact etween raw !oods and coo#ed!oods

C"oose !oods processed !or sa!ety as" "ands repeatedly

Keep all #itc"en sur!ace clean

4se sa!e water


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"o you prepare food safety8

Coo#ing #ills germs T"oroug"ly coo# all meats, !is", and vegetales Eat t"em w"ile t"ey are "ot

as"ing protects !rom water


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Disposal of Dead Bodies in

Emergencies


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Mortuary Services

t is important to provide secure mortuary !acilities i! urialor cremation are li#ely to e delayed

A temporary mortuary site s"ould consist o! a reception, aviewing room, a storage c"amer !or odies not suitale !orviewing and a room to store personal possessions and

records Bodies s"ould e stored at @&C, alt"oug" t"is is rarely

possile /ortuary sta!! s"ould wear gloves and protective clot"ing

and s"ould was" wit" disin!ectant soap

T"e minimum !acilities are stretc"ers, leat"er gloves,ruer gloves, overalls, oots, caps, soap, disin!ectants andcotton clot"

To close a temporary mortuary, appropriate cleansing o!t"e site s"ould ta#e place

B d Di l


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Body Disposal

Burials in common graves and mass cremation are rarelywarranted and s"ould e avoided Burial is t"e pre!erred met"od o! ody disposal in emergency

situations unless t"ere are cultural and religiousoservances w"ic" pro"iit it

T"e location o! graveyards s"ould e agreed wit" t"ecommunity and attention s"ould e given to groundconditions

An areas o! at least 7%&& m> 0 7&&&& population is re3uired T"e urial site can e divided to accommodate di!!erent

religious groups i! necessary

Burial dept" s"ould e at least 7% m aove t"e groundwatertale, wit" at least a 7 m covering o! soil

Burial in individual graves is pre!erred Burial procedures s"ould e consistent wit" t"e usual

practices o! t"e community concerned


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Publications

Re!erence: "ttp:00wwww"oindiaorg0E0Section660Section6@O7)@)"tm


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EH Measures for Disease Control After Emergencies

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