Tsunami threats: the long and short of it

We now know that the catastrophe of December 26, 2004, was one of the greatest natural disasters in history. The tsunami that ripped through the Indian Ocean stole more than 150,000 lives and left thousands more injured, homeless, orphaned, and desperate. What we don't yet know are the long-term threats to public health that the tsunami will leave in its wake.

The primary effects of the sea surge have been made clear in the weeks that have passed. The majority of deaths were a direct result of drowning and traumatic injuries. The force of the waves washed away houses, medical facilities, fisheries, and food supplies. The impact of this devastation is tangible and evident, but the long-term threats to public health are more uncertain, and the threat of an epidemic looms. Damage to sewer systems and contamination of drinking water supplies poses the gravest threat and can lead to a multitude of water- and food-borne diseases such as cholera, hepatitis A and E, diarrhea, typhoid fever, shigellosis, rotavirus, and leptospirosis. Pools of standing water pose the threat of mosquito-borne diseases such as malaria and dengue fever. Overcrowding in refugee camps raise the risk of pneumonia and other respiratory ailments.

Preventive measures are in place to ensure the safety of area inhabitants – careful surveillance, distribution of health kits and chlorine tablets, vaccinations, education, organization of resources, and relief efforts will all help to keep epidemics at bay and preserve the heath of survivors. “Now that the crisis is weeks old, the risk of major outbreaks directly resulting from the tsunami . . . may already be behind us, and will probably be almost gone by the end of three months,” says Les Roberts, a water engineer and disaster expert at the Johns Hopkins Bloomberg School of Public Health. But, he adds, “Disasters which ravage economies can elevate infant mortality and disease transmission patterns for years.”

The mental consequences of this catastrophe also pose an insidious threat. Although psychosocial services are being provided in some areas by international organizations, the long-term effects can only be speculated. The incidence of posttraumatic stress disorder and depression is expected to be very high. Survivors also face a lasting sense of loss, fear, helplessness, and shell shock, says Carol Etherington, former president of the US board of Doctors Without Borders and an expert on international volunteer efforts who has worked with the International Medical Corps and the Red Cross. Adults can cope with and make sense of a natural disaster, she explains, but children will have a harder time putting the horror into context. But, she adds hopefully, “people are resilient.”