Emergencies: global and local impact
Wars, cyclones, earthquakes, tsunamis, disease outbreaks, famine, radiological incidents and chemical spills – all are emergencies that, invariably, impact heavily on public health. Internal emergencies in health facilities – such as fires and loss of power or water – can damage buildings and equipment and affect staff and patients. In conflicts, reasons for hospital breakdowns include staff being forced to leave due to insecurity and the looting of equipment and drugs.
In 2008, 321 natural disasters killed 235 816 people – a death toll that was almost four times higher than the average annual total for the seven previous years. This increase was due to just two events. Cyclone Nargis left 138 366 people dead or missing in Myanmar, and a major earthquake in south-western China's Sichuan province killed 87 476 people, according to the United Nations’ International Strategy for Disaster Reduction (UNISDR). Asia, the worst-affected continent, was home to nine of the world’s top 10 countries for disaster-related deaths. Along with other weather-related events, floods remained one of the most frequent disasters last year, according to UNISDR. Conflicts around the globe have also led to great human suffering and have stretched health care services to the extreme.
Disasters also exact a devastating economic toll. In 2008, disasters cost an estimated US$ 181 billion – more than twice the US$ 81 billion annual average for 2000–2007. The Sichuan earthquake was estimated to cost some US$ 85 billion in damages, and Hurricane Ike in the United States cost some US$ 30 billion.
"The dramatic increase in human and economic losses from disasters in 2008 is alarming. Sadly, these losses could have been substantially reduced if buildings in China, particularly schools and hospitals, had been built to be more earthquake-resilient. An effective early warning system with good community preparedness could have also saved many lives in Myanmar if it had been implemented before Cyclone Nargis," said Salvano Briceno, the director of UNISDR.
Although only 11% of the people exposed to natural hazards live in developing countries, they account for more than 53% of global deaths due to natural disasters. The differences in impact suggest there is great potential to reduce the human death toll caused by natural disasters in developing countries – and that the key ingredient in these tragedies is human inaction.
This is only one part of the picture. There are many smaller-scale events that inflict an even greater toll in terms of human suffering, such as in the case of vehicle accidents and fires. Road traffic crashes kill 1.2 million people annually, or more than 3200 people a day, while a further 20–50 million people are injured or disabled every year. At least 90% of road and fire fatalities occur in low- and middle-income countries. There are also 300 000 deaths each year from fires alone.
Outbreaks of communicable diseases can spark emergencies that cause widespread death and suffering. In the 12 months up to 31 May 2008, WHO verified 162 outbreaks of infectious disease in 75 countries worldwide. More than a third of the outbreaks occurred in Africa. They included cholera, other diarrhoeal diseases, measles, haemorrhagic fevers and other severe emerging diseases.
"The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks after disasters are associated primarily with population displacement (commonly linked to conflict)." Even a few cases of a given disease can give rise to the perception that the public faces a grave health risk, which can lead to major political, social and economic consequences.
Infectious diseases are major causes of death and illness in children in conflict settings, especially among refugees and the internally displaced.