While a lot has been said about the shocking devastation in Nepal due to the unprecedented flash floods, it must not be forgotten that such natural disasters require a prolonged recovery and the costs associated with such events are not economic alone. The human costs are much higher and long after the first responders have left, the people of the affected region continue to pay a heavy price. Over and above the fatalities and the injuries, disrupted water and sanitation, shortage of medicines and medical supplies, proper transport and availability of routine care go on for weeks, months and even years, turning manageable illnesses into emergencies simply because help is unable to reach people in time.

How Receding Floodwater Impacts Long-Term Health Of A Region

1. Contaminated water and poor sanitation:

Floodwater, mixed with sewage, animal waste, refuse and sometimes industrial contaminants, raises the risks of diarrheal diseases, cholera, typhoid, hepatitis A and E, leptospirosis, skin and eye infections. Stagnant water can also encourage vector breeding (mosquitoes are being increasingly seen at higher altitudes and wider latitudes) increasing the risk of malaria and dengue.

Disease epidemics may not be an automatic result of floods. Outbreaks happen people are crammed into crowded shelters with limited access to safe drinking water, lack of toilets, no handwashing facilities and irregular waste disposal practices. People at extremes of age (children and older adults), pregnant women and those with established chronic conditions or those already undernourished are especially vulnerable to such diseases.

The immediate public-health priorities are safe drinking water, functioning toilets, hand hygiene, safe food, proper waste disposal and prompt recognition of disease symptoms by trained medical professionals. Boiled or chlorinated water should be used for drinking and for preparing food, if floodwater comes into contact with food it must be discarded, walking in contaminated water should be avoided and early care seeking for symptoms becomes essential.

Also Read: Nepal Floods: Floodwater May Spread Infectious Diseases, How To Stay Safe

2. Reduced access to medicines and healthcare:

The destruction caused by natural disasters goes far beyond fatalities. Roads disappear, medical centers get washed away, power supply stops, communications fail - all resulting in interruption of routine but life-sustaining care. A person with diabetes who needs regular insulin can run out of it, someone with hypertension or heart disease may have to miss medication, serious patients needing dialysis, oxygen, tuberculosis or HIV treatment, antenatal care, emergency obstetric care, epilepsy medicines or mental-health treatment are simply not able to access health services.

Hospitals and medical centers may be physically damaged or overwhelmed with no power and increasing patient needs, while health workers themselves may be rendered homeless, and be unable to travel. This can lead to health complications, avoidable emergencies, distant hospital admissions and even deaths from chronic illness. Continuity of primary care is an integral part of disaster response and preparedness with mobile teams, tele-triage (if connectivity exists), pre-mapped and assigned referral routes, community health workers and protected medicine stocks become critical.

3. Mental-health impact on survivors and emergency teams:

Most of us watched video clips of the disaster and have felt affected. But think about those who experienced the disaster themselves - the feelings of fear, grief, disrupted sleep, irritability, anxiety and uncertainty start early and linger on for extended periods of time. Survivors have been known to develop post-traumatic stress disorders (PTSD), chronic persistent depression, anxiety disorders, substance use problems ("to numb the pain"), particularly after bereavement, injury, displacement, loss of livelihood, and family separation.

Emergency workers are no less at risk. Long shifts - racing against time to save as many as possible, exposure to multiple deaths and extensive injuries, difficult triage decisions, inadequate resources at hand, concern for their own families and consequent poor sleep leads to exhaustion, burnout, distress and psychological trauma. Rescue teams and emergency workers need to be rotated, be provided safe accommodation, food and water, peer support, confidential access to counselling and clear leadership - not simply an expectation to "be resilient."

The correct first-line approach is one that is practical, humane, restores safety, provides accurate information, encourages family contact and creates access to shelter, food, medicines and community support. Frontline workers need to be trained in psychological first aid and there must be established referral pathways for those with persistent or severe symptoms.

Also Read: Nepal Principal Tells NDTV How He Saved 900 Children From Floods In Minutes

4. Medical preparedness for organizations in high-risk locations

Medical preparedness is an area that no project in harsh, challenging environments can ignore. Hydroelectric projects, mining sites and other remote operations must treat emergency preparedness as a core safety function, and not an add-on to rescue planning. At minimum, every organization working in a risk-fraught environment should:

  1. Conduct site-specific health and hazard risk assessment for natural disasters, chemical accidents, road access disruptions, communication failures and the resulting health sequelae.
  2. Have a regularly tested emergency medical response plan with clear command roles, 24/7 contact lists, mapped evacuation triggers, information about alternate road/air/water routes, muster points and working links to district and state authorities, hospitals and ambulance providers.
  3. Stock adequate supplies of medication, trauma and wound-care kits, oral rehydration salts, safe-water treatment supplies, antibiotics (only under clinical supervision), PPE, splints, oxygen where feasible, defibrillators, and equipment for snakebite and hypothermia risk where relevant. These need to be stored in multiple locations to reduce the risk of them all being washed away / destroyed.
  4. Maintain adequate stocks of routine medication that may be required by staff working on the site. This includes medicines for cardiovascular diseases like hypertension, chronic conditions like diabetes etc.
  5. Train staff and contractors in first aid, bleeding control, safe evacuation, water and sanitation practices, infection prevention, psychological first aid and referral criteria. Run several multi-stakeholder drills before each season and create a plan of action to mitigate any risks that become apparent.
  6. Satellite phones / ham radio communication, backup power, clean-water storage and treatment, emergency sanitation, protected health records, and alternative staffing arrangements help to build redundancy
  7. Designate an Emergency Response Team to establish rapid surveillance and reporting - daily counts of diarrhea, fever, respiratory illness, injuries, animal bites etc.
  8. Protect designated responders through shift limits, buddy systems, PPE, rest, mental-health support and a strict rule that no rescue task proceeds when conditions are unsafe.

(By Dr Vikram Vora, Medical Director - Consulting International, Indian Subcontinent and Middle East, International SOS)



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