Disaster Relief - Analysis of 2005 South Asian Earthquake

It’s hard to imagine a more devastating disaster than a powerful earthquake. They come without notice; completely unpredictable even in our age of technology. They last barely seconds but manage to level cities centuries old. The destruction left by earthquake is often irreparable and rebuilding of structures, restoring of power and water, etc may take months or years to complete. However, more devastating then the lack of shelter, power, etc is the disruption of health care. Those injured in major earthquakes can number in the hundreds of thousands and most likely, health care in the area is heavily disrupted if not shut down altogether. Those with minor injuries who otherwise would have received treatment may have to wait days before being seen by doctors and even longer before receiving care. Most vulnerable in earthquake disasters, or any disasters for that matter, are developing countries with poor infrastructure, remote populations, and difficult terrain. The 2005 major earthquake that shook the mountains of Kashmir was the third deadliest disaster in the last quarter century. The 7.6 magnitude quake leveled the cities of Muzaffarabad, Balakot, and Abbottabad and destroyed innumerable villages in those and neighboring regions.

The earthquake struck Northern Pakistan just northeast of the capital of Azad Kashmir district, Muzaffarabad. Muzaffarabad is a large city with a population of over 750,000, located in a river valley and surrounded by mountain villages. On the morning of the earthquake, October 8, 2005, most men were at work in the open fields, while majority of women and children were at home and school respectively. When the earthquake hit at 9 am that morning, children in their classrooms experienced their schools collapsing on them, while shelter homes in the mountains crumbled and fell. In a report put together by the Spinal Cord Injury Project for Pakistan Earthquake Rehabilitiation (SCIPPER), children reported hearing a “deafening sound and forceful shaking” which sent them tumbling down. The walls of their school collapsed, killing hundreds of children instantly and trapping the rest of them. Confusion and panic spread as they lay injured under the rubble, surrounded by dead classmates and screaming. The injured children lay for hours until they were rescued by family or community members. Many sustained spinal cord injuries which left them paralyzed from the neck or waist down. The shock of being unable to move their arms and leg was horrifying; just earlier that day they were “running and playing with their friends.” Far from being cared for or comforted, the paralyzed victims of the earthquake were left lying outside for days until helicopters came and took them to care facilities. Because of the mountainous terrain, most affected villages and cities were already difficult to access because of poor roads and weather conditions. After the earthquake, landslides essentially blocked all access to the region, making care even more difficult to access.

In addition, Pakistan was not properly prepared to manage such a huge natural disaster and didn’t have the means to respond quickly and efficiently. It took weeks to reach most of the affected villages and because of the quake, most proximal health care facilities were destroyed so victims had to be airlifted elsewhere. It was reported that of the nearly 512 healthcare facilities in the affected area, approximately 300 of them were completely destroyed while nearly 75 were seriously damaged. The lack of facilities and competent doctors was exacerbated by the landslides and road blockages which made most villages accessible only by helicopter. The condition worsened in the following days as the few health care facilities that were still open became extremely overcrowded as victims were flown in. The immediate priority of the doctors was surgical care for patients that were severely injured. However within days it became clear that lack of access to clean water, sub par sanitation conditions, and overcrowding were of greater concern. Patients who received surgical care continued to suffer from life-threatening infections due to unhygienic conditions. The overburdened care facilities could not provide follow-up care for many patients post-operatively simply due to the sheer volume, which indirectly resulted in lives lost.
The level and nature of the training of much of the medical provider was not adequate to prepare them to treat affected patients. Many senior medical students, in their fourth year, were sent to the mountain region to help the rescue efforts. Not only had they received no formal training in disaster relief medicine, they were hardly accustomed to making independent decisions without the approval of their attending physicians. When they finally arrived in the affected regions, it had been a few days since the quake and people were desperate for medical attention. The burden of having to prioritize patients by severity of condition and treating them independently was overwhelming for the untrained and unprepared medical students. In addition, the majority of them had never had to practice medicine without the facilities of a hospital or even more basic needs such as anesthesia, clean water, or proper prescription medicines. The adaptability required of those treating earthquake victims definitely hindered relief efforts and better preparation of medical students would have been invaluable in making them more efficient first responders to this disaster situation.
An unexpected crisis that arose after the quake was the outbreak of infectious disease in the shelter camps. The state of Pakistan’s development in terms of availability of water, power, and safe road conditions was unreliable even before the quake. Afterwards, approximately 144 camp settlements were established to shelter nearly 144,000 residents. The close proximity in which masses of people lived caused huge outbreaks of disease, with nearly 65% of all clinic visits being to treat infections. Generally, acute respiratory disease, such as pneumonia, and diarrhea were among the chief complaints, especially once the winter set in. The tents set up in these settlements were not meant to be used in the harsh cold of Kashmir’s winter, and the death toll continued to rise through the first winter season. Winterization of the tents became increasingly important to enable the survival of the displaced village populations. Even now, three years after the earthquake, access to food and water continue to remain unreliable, especially since the initial influx of international aid dropped steeply after the first few months. Many people are still living in prefabricated homes which are unable to protect residents from the elements and could most definitely not withstand another earthquake. Roads have not been permanently rebuilt yet either, forcing patients with lifelong conditions to travel for hours or even days to receive proper medical attention when needed.
Death caused by a natural disaster is unfortunate and unavoidable. However, every effort to reduce the number of deaths and the injuries sustained by a population must be made. The time lag in reaching the affected regions, the consistently poor access to basic needs such as clean water and the lack of disaster preparation of the medical teams all contributed to the enormous death toll of nearly 75,000 and those injured numbering 100,000. Although international aid is of invaluable help in facing these kinds of disasters, ultimately it is the responsibility of every nation to prepare themselves against disasters which pose the largest threats in their regions.

References
1. Suharwardy, Sanaa. Personal interview. 10 Apr 2009. Interview.
2. Brennan , Richard J., and Ronald J. Waldman. "The South Asian Earthquake Six Months Later - An Ongoing Crisis." The New England Journal of Medicine (2006): 1769-1771. Print.
3. Sabri, Ahmed A., and Muhammad A. Qayyum. "Why Medical Students Should be Trained in Disaster Management: Our Experience of the Kashmir Earthquake." PLoS Medicine 3(2006): 1452-1453. Print.
4. Vanek, Zeba. "SCIPPER-Medical Neuro-Rehabilitation and Creating an Ongoing Sustainable System of Medical Care." RealMedicineFoundation.org Oct 2007 1-5. Web.11 Apr 2009. .