Ten days after the massive earthquake which has killed over 12,000 people, left an estimated 200,000 homeless and destroyed infrastructure in a 5,000 square-km-wide area, the most pressing health priority is the re-establishment of proper water and sanitation services, the World Health Organization (WHO) said today.

Other priorities include the establishment of infectious disease surveillance systems, the re-establishment of basic health care services and the provision of mental health services. Injury rehabilitation remains an acute strain on Turkey's existing health facilities, although the number of such patients being treated is expected to decline from now on. In the longer term, the re-building of water and sewage systems, the re-starting of vaccination programmes and the provision of the full range of primary health care services, especially maternal health care, should be priorities, WHO says.

The risk of infectious disease epidemics is, on the other hand, very limited. "In over 20 years of tracking natural disasters, WHO has not found one instance of a disease epidemic occurring in the aftermath of an event," emphasized Dr Lindsay Martinez, Director of WHO's Department of Communicable Disease Surveillance and Response.

Moreover, diseases such as cholera are very unlikely to appear in the region simply because the pathogen Vibrio cholerae is not present in the environment and has not been found in Turkey for almost 30 years, said Dr Martinez. "Other diseases, such as typhoid fever, of which sporadic cases can occur in many places, might appear even without the occurrence of a disaster like an earthquake. An isolated case or cases, even now, do not mean that an epidemic is about to occur."

The primary disease threats are waterborne diseases, because of unsafe water, and acute respiratory infections, due to over-crowding. Consequently, "we need to ensure that, until water and sewage infrastructure can be rebuilt, enough safe water is provided to people in the region or, failing that, people know that they need to boil or chlorinate all water first," said Dr Martinez.

Floods and heavy rainfalls may contribute to an increase of ordinary diarrhoeal diseases and therefore a proper, well-established disease surveillance system is considered essential. Access to sanitation services, safe water and personal hygiene practices will reduce the risk for any diarrhoeal disease to a minimum.

One surveillance post to give an early warning of possible disease occurrence and spread has already been set up by the United States Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID) at Izmit. WHO is recommending that additional surveillance systems be set up throughout the affected region in order to give adequate warning of possible infectious disease risks, particularly among those people made homeless by the earthquake.

"We have worked extensively with the Turkish Ministry of Health. In the coming weeks, we will be working with the Ministry to rebuild basic health services in the affected areas, while another lasting priority will be the provision of mental health services," said Dr Eric Noji of WHO's Department of Emergency and Humanitarian Action, who has just returned from Turkey.

Another public health priority in the months (and years) to come is provision of adequate rehabilitation medicine and physical therapy services. For example, following the 1988 earthquake in Armenia (approximately 40,000 deaths), there were hundreds of injured who were left with permanent musculoskeletal or neurological disabilities requiring life-long specialty (and expensive) health care -- a problem for a health system with already limited resources.

For further information, journalists can contact Gregory Hartl, Office of Press and Public Relations, WHO, Geneva. Telephone (41 22) 791 44 58. Fax (41 22) 791 48 58. E-Mail: hartlg@who.int