Following natural disasters, much attention is given to the threat of disease. This week our attention is focused on the earthquake in Haiti — its victims and its survivors. Though there is some reason for concern for survivors and relief workers, not all that we hear about as public health concerns is necessarily true.
It is commonly believed that the presence of dead bodies causes disease and there are many epidemics imminently threatening the survivors of earthquakes. These are myths. According to the World Health Organization (WHO), the presence of cadavers is not a widespread problem. Contamination of the water supply can occur in very limited cases when the cadavers are in contact with the water system thereby transmitting gastro-enteritis. The organization further states that cadaver removal has little impact on the transmission of cholera.
Further, diseases transmitted by mosquitoes such as malaria and dengue are not associated with the presence of cadavers. According to David Tschanz, a medical and military historian reporting on the experiences of the quakes in Iran (2003) and Turkey (1999), a relationship between cadaver and epidemics has never been scientifically demonstrated or reported. There is, of course, a social and cultural obligation to take care of dead bodies. And, consideration must be given to the effect of survivor mental health living with the reality of open mass graves and uncollected bodies.
Regardless of the number of casualties and crush survivors, most injuries are minor cuts and bruises. A smaller group suffer from simple fractures and a minority of victims have serious multiple fractures or internal injuries requiring surgery and other intensive treatment.
Eighty-five to ninety-five percent of persons rescued from collapsed buildings are rescued in the first 24-48 hours after the earthquake. Following an earthquake, patients tend to appear at medical facilities in two waves, the first wave of casualties are from the immediate area around the medical facility and the second wave occurs as humanitarian operations in more distant areas become organized. Victims of secondary disasters may arrive at later stages.
History has shown that a week after the earthquake, the surgical demand and the demand in health care in general is typically back to normal. Late arrival of referred patients and injuries due to secondary disasters may occur.
As our hearts go out to these victims and their families we are reminded that, for years, the Haitian government has relied on foreign aid to keep itself and its economy operating. The standard of living for Haitians is grim. According to the US government census and reporting statistics, 1 in 8 children die before age 5. The life expectancy is 59 to 62. Haiti is still plagued with illnesses long ago wiped out in the industrialized world. Though illnesses like cholera and malaria are not expected as a normal post-disaster threat, Haiti’s pre-earthquake condition may skew the statistics.