Natural Disasters, Armed Conflict, and Public Health

Posted by • November 8th, 2013

Global disasters, whether natural or caused by humans, affect health in many ways, as reviewed in the latest article in our Global Health series.

Natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity. But in recent times, the scale and scope of these events have markedly increased.

Clinical Pearls

• How are disasters classified?

Disasters are broadly classified as biologic, climate-related (hydrometeorologic), or geophysical. There were three times more natural disasters in 2000 through 2009 compared to 1980 through 1989.

Although better communications may play a role in the trend, the growth is mainly in climate-related events, accounting for nearly 80% of the increase, while trends in geophysical events remain stable.

Table 1. Classification of Natural Disasters.

Figure 1. Numbers and Types of Natural Disasters, 1950-2012.

• What are the main health consequences in internal armed conflicts?

The main health consequences in internal armed conflicts are not combat-related injuries and deaths. Mortality is driven by many direct and indirect factors, of which severe malnutrition, malaria, or other common childhood diseases are the main ones. Typically, health status deteriorates as violence and insecurity lead to population displacements and the breakdown of health care systems and supply chains, which in turn degrade essential services such as vaccination programs, maternal care, and therapeutic feeding.

Figure 3. Conflict-Related Deaths. 

Morning Report Questions

Q: In the setting of disaster, after what time interval does the probability of survival from serious injury decrease substantially?

A: In acute disasters, such as earthquakes and cyclones, physical trauma may require specialized interventions. Probability of survival from serious injury decreases substantially 12 to 24 hours after the disaster impact and good outcomes in most cases are thus highly dependent on rapidity of appropriate medical and surgical response. Advance preparedness of local health care personnel in search-and-rescue capacities and acute emergency care is crucial to improving victim survival. An additional requirement, less widely recognized, is for adequate local follow up nursing care and infection control in postoperative settings and rehabilitation services.

Q: What is the Standardized Monitoring and Assessment of Relief and Transitions (SMART)?

A: In response to growing concerns regarding equity and needs-based response, public health analysts within the humanitarian community worked to identify thresholds of key indicators of mortality and malnutrition in order to classify situations as critical and to serve as triggers for provision of emergency relief. Recognizing the major implications of using such thresholds, a group of academics, nongovernmental organizations, and UN agencies developed SMART, a rapid cluster survey method to provide statistically sound estimates of mortality and malnutrition. Now widely used by relief agencies, this method generates comparable epidemiologic data to quantify crises thresholds and monitor the effectiveness of the relief, strengthening evidence based response. As the SMART method does not require household listing, it has advantages over random sampling. But the relative uncertainties of cluster sampling (lower levels of precision and constraints on extrapolation of key parameters such as mortality) can prove problematic, since risks are highly variable across small areas.

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