The Public Health Consequences of Disasters

Mark Keim, M.D. Centers for Disease Control and Prevention

Definition of Disasters
A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.
WHO, 1998

Classification of Disasters

  

Natural HumanHuman-generated Hybrid natural disasters

Human-Generated
  

 

Fires and explosions Structural collapse Hazardous material release Transport crashes Violence

Hybrid Natural Disasters

 Situations in which one category of disaster may trigger another Fire & explosions after earthquakes Toxin spread after floods Windstorm spread of radiation Air pollution after thermal inversions

Classification of Natural Disasters

Slow onset
Drought, desertification Deforestation Famine, pests

Unicef

Classification of Natural Disasters

Rapid Onset
 Climatic Floods Storm surges Windstorms Wildfires Heat waves Dust storms Snowstorms  Geological Earthquakes Tsunamis Volcanic Landslides Avalanches

The Four Elements of Rapid-Onset Natural Disasters

 Earth
Avalanches, earthquakes, landslides, volcanoes

 Wind
Hurricanes, tornadoes, dustduststorms

 Water
Floods, snow & ice-storms, icestorm surges, tsunamis

 Fire
Wildfires, heat waves
Keim, 1998

Five Worst Disasters Worldwide, 1945-1990

 Cyclone Bangladesh, 1970, 500,000 dead  Earthquake China, 1976, 250,000 dead  Earthquake USSR, 1948, 100,000 dead  Earthquake Peru, 1970, 70,000 dead  Flood China, 1949, 57,000 dead
USOFDA,1995

Disasters Ranked by Number of Lives Lost Worldwide, 1947-80

1. Cyclones 2. Earthquakes 3. Floods 4. Thunderstorms & tornadoes 5. Snowstorms 6. Volcanoes 7. Heat waves 8. Avalanches 9. Landslides 10.Tsunamis 10.Tsunamis
Shah,1983

Top Ten Countries by Number of Disasters (1966-1990)

 Industrialized Countries  Developing Countries Hong Kong: 220 Philippines: 272 Australia: 154 India: 216 USA: 114 China: 157 New Zealand: 89 Indonesia: 139 Japan: 80 Bangladesh: 139 Soviet Union: 67 Peru: 100 Italy: 51 Iran: 73 Canada: 38 Mexico: 64 France: 37 Vietnam: 41 Greece: 37 Turkey: 41
CRED,1993

Vulnerability to Natural Disasters



95% of natural disaster deaths occur among 66% of the poorest countries1 From 1965-1992 more 1965than 90% of all disaster victims lived in Asia & Africa2

1Anderson, 1991
2 IDNDR,

1994

Public Health Consequences of Natural Disasters

    

  

Death Injuries Loss of clean water Loss of shelter Loss of personal household goods Major population movements Loss of sanitation Loss of routine hygiene Disruption of solid waste management

  

 

 

Public concern for safety Increased pests & vectors Damage to health care system Worsening of chronic illnesses Loss of electricity Toxic/ hazardous exposure Loss of food supply Standing surface water

Technological Disasters


Unintentional
Industrial incidents Structure failure Transportation crashes Military accidents Radiation disasters Fire disasters

Intentional
Armed conflicts & warfare Terrorism & sabotage Deforestation Desertification Pollution

Examples of Unintentional Technological Disasters

 

Explosions Mexico City Butane facility, 1984 Fires Torrance, CA Oil Refinery Fire, 1989 Spills Crude oil: Prince William Sound, Alaska, 1989 Releases Radiation: USA, 1979; USSR , 1986

Examples of Unintentional Technological Disasters



Industrial chemical release Bhopal, India 1984 Fire disaster MGM Grand Hotel Fire Nevada, USA 1980

Examples of Unintentional Technological Disasters



Transportation crashes Airliner crashes are major causes of mass fatalities Structural failure Hyatt Regency Skywalk collapse, USA 1981 Military incidents Sverdlosk, USSR 1979

Examples of Intentional Technological Disasters

 

 

Warfare Conventional weapons & WMD Terrorism Conventional weapons & WMD Deforestation & desertification Pollution Research

Conventional Warfare


War famine : Angola, Mozambique, Ethiopia, Somalia - Kates 1993 Complex emergencies: internal & external refugees Disruption of public services: Sarejevo, services: Iraq Hazardous chemical release: Kuwait oil release: well fires - Etzel, 1994 Continuing threats: Landmines: Afghanistan, Bosnia

Non-Conventional Warfare (WMD)

 Thermonuclear Hiroshima & Nagasaki 1945  Chemical Mustard:  W.W.I - Germany 1917  W.W.II - Italy 1938  Iran-Iraq war 1980 s IranLewisite: Japan 1938  Biological Plague & Anthrax  Japan Unit 731 Manchuria, 1937

Terrorism


Improvised Explosive Devices Transport crashes - Lockerbie, Scotland Structural collapse & fires: WTC & OK City, USA Vehicle-laden bombs Vehicle Ireland, UK, Israel, USA, Bali, Indonesia

WMD Terrorism


Radiological: Radiological:
Chechnyan dirty bomb threat 1996 Biological: bacteria, viruses & toxins Anthrax & Botulinum: Aum Shinrikyo cult Tokyo 1994 Salmonella: Baghwan Rajneesh cult The Dalles, OR 1984 Plague: Aryan nation member Lancaster, Ohio, 1995

WMD Terrorism
Chemical: Sarin: Aum Shinrikyo cult  Matsumoto 1994  Tokyo 1995 Cyanide: Al Qaida  US embassy, Rome 1999

Acts of God and Acts of Men



The public tends to judge technological hazards much more harshly than natural hazards of similar magnitude
1 Glickman

Most Americans believe that they face more risk today than in the past and that future risks will be even higher.2
2

Slovic 1987

1992

Complex Technological Disasters



The crisis phenomenon itself is undergoing a transformation. ...not only do we have to deal with localized failure; rather, we must react to trends that unravel the fabric of organized systems... 2
Keim, 1998 2 Lagadec, 1998
1

Thank you
Questions or comments?

mjk9@cdc.gov