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Conflict And Catastrophe Medicine > Disasters And Diseases > Flashcards

Disasters And Diseases Flashcards

1
Q

Learning Objectives

A
  • The health effects of disasters, groups particularly at risk and the communicable disease risks involved
  • The communicable diseases most commonly associated with disasters
  • Being aware of The essentials of the control of communicable disease in disasters (Assessment, Prevention, Surveillance, Outbreak control, Management of
    cases)
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2
Q

What does the nature of disasters determine?

A
  • The patterns of morbidity & mortality
  • Subsequent health problems
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3
Q

List other factors that can influence the health effects of disasters

A
  • Multi factorial
  • Nature of the disaster! Duration! Location, Affected population, Access, Effects on infrastructure, Security, Endemic/epidemic diseases
  • These will in turn affect the nature of the response needed
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4
Q

Describe the features of an Earthquake/Tsunami

A
  • Release of vast amounts of energy
  • Wide areas affected
  • Earthquakes >Force 7 on Richter Scale causes:
  • Extensive destruction
  • Many fatalities
  • Population displacement
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5
Q

List the effects of an Earthquake/tsunami

A
  • Trauma: many with minor cuts & bruises! smaller group with simple fractures, a minority need surgery / other intensive treatment. Serious multiple fractures, internal injuries & crush syndrome
  • Drowning
  • Asphyxia
  • Dust inhalation
  • Burns and electric shock
  • Environmental exposure (hypothermia)
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6
Q

State one human made disaster and their features

A
  • Terrorism:
  • May be many casualties
  • Access to casualties may be difficult
  • Terrorist attacks frequently in built-up areas
  • Security of responders
  • Not just explosives: Gunshot/knifing, Vehicle as weapon, Biological agents, Poison gas
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7
Q

List the range of injuries caused by terrorism attacks

A
  • Wide range of injuries
  • Blast
  • Ballistic
  • Trauma
  • Crush
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8
Q

Describe the features of disasters & communicable diseases

A
  • Natural disasters: Acute onset
  • Trauma is usually the main immediate cause of morbidity & mortality,
  • Communicable diseases (CD) occur later
  • Outbreaks of CD less frequent in natural disasters than in conflicts
  • Long term: Morbidity & mortality often related to malnutrition
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9
Q

Describe the features of conflicts

A
  • In many wars more people die from illness than trauma
  • Estimates of mortality:
  • Darfur (2004 – 8): > 80% of ca. 300,000 deaths due to disease*
  • Yemen (to end 2021) 60% of deaths [227,000/377,000] due to indirect causes (famine, disease) (UNDP Nov 2021)
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10
Q

List the Factors increasing risk of disease outbreaks in
disasters

A
  • Breakdown of control measures
  • Damage to: Health facilities, Infrastructure (e.g. water, sewage, power supplies etc.)
  • Loss of staff
  • Damage to or loss of programmes: immunisation, vector control, WASH
  • Contamination of water & food
  • Breakdown of long term treatment programmes: Infectious agents (e.g.TB), Non infectious illnesses
  • Increased susceptibility
  • Displacement
  • Crowding
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11
Q

What are the risk factors for communicable diseases commonly associated with?

A

Associated primarily with population displacement

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12
Q

Which groups are at high risk following a disaster?

A
  • Displaced people
  • Children (especially <5Y & unaccompanied)
  • Women (especially pregnant women & nursing
    mothers): >75% of refugees & IDPs at risk are women & children, ~25% of these are women of reproductive age, 20% of these likely to be pregnant
  • Elderly people
  • Disabled people
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13
Q

List the risks to displaced individuals?

A
  • Health status of displaced population
  • Access to healthcare
  • Increased susceptibility
  • Reduced immune competence due to: Stress, Poor diet, Malnutrition
  • “New” organisms
  • Water & Sanitation
  • Contaminated food
  • Crowding
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14
Q

List the risks to the host population

A
  • Imported organisms
  • Malnutrition: overexploitation of resources
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15
Q

Using Gaza as an example, how many people have been killed or displaced?

A
  • Nearly 42,000 people have been killed in Gaza since the start of the war on Oct 7th 2023
  • Around 1.9 million people (9/10Gazans) have been displaced at least once
  • They also have a soaring rate of infectious diseases such as diarrhoea and upper respiratory infection
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16
Q

Describe the situation in Ukraine due to the conflict occurring (PART 1)

A
  • Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in Ukraine
  • Disruptions in treatment for chronic cardiovascular & respiratory diseases likely to increase morbidity & mortality
  • Low immunization rates for all vaccine-preventable diseases
  • High HIV & resistant TB rates
  • The war has weakened TB surveillance capacity & interrupted treatment.
  • Risk of an increased spread of drug-resistant TB.
17
Q

Describe the situation in Ukraine due to the conflict occurring (PART 2)

A
  • Overcrowded shelters, population displacement, infrastructure damage, lack of adequate WASH, nutritional stress & exposure to cold weather during winter, could increase the risk of respiratory & diarrhoeal diseases, including cholera
  • Critical to strengthen the early warning and alert component of the disease surveillance system to capture the various hazards.
18
Q

What are the common diseases occurring to displaced individuals?

A
  • The Communicable Diseases facing displaced persons
    will generally be those:
  • In the areas through which they have moved
  • n the areas to which they have moved
  • They brought with them from home
19
Q

What diseases are more likely to cause immediate problems than others?

A
  • Respiratory / respiratory route (crowding)
  • GI (impure water, contaminated food)
  • Vector borne (breakdown of vector controls & possibly
    increase of breeding potential for vectors)
20
Q

List the conditions which consistently account for 60-95% of deaths in displaced individuals

A
  • Acute respiratory infection (ARI), Malnutrition, Diarrhoea, Measles, Malaria
  • Need to consider the long term as well as the
    short: TB, HIV/AIDS
21
Q

Describe respiratory diseases amongst displaced individuals

A
  • ARI: major cause of illness & death in displaced populations
  • Children <5Y especially at risk: #1 infectious disease killer of children <5Y
  • Risk of death from ARI increased by lack of access to: health services, antimicrobial agents for treatment
  • Risk factors among displaced persons
    include: crowding, exposure to indoor cooking using open fires, poor nutrition
22
Q

List other important diseases transmitted via the respiratory tract

A
  • Measles
  • Diphtheria
  • Pneumonic plague
  • Bacterial meningitis
  • COVID-19 (& other Coronaviruses)
  • All of these have disaster implications
23
Q

What are the problems when it comes to malnourished individuals?

A
  • Malnourished individuals have an increased susceptibility to infection
  • PEM & micronutrient deficiencies damage the immune system
  • Malnutrition magnifies the effects of disease
  • More severe disease episodes
  • More complications
  • Longer duration of illness
24
Q

Describe the features of diarrhoea diseases

A
  • The big three: Cholera (acute watery diarrhoea)! Dysentery (bloody diarrhoea), Typhoid (Enteric fever)
  • Many other causes of GI infections - usually endemic not
    epidemic - can cause much morbidity
  • NB. Diarrhoea +/- vomiting +/- fever may be a symptom of
    another type of disease – not a GI infection!
  • Treatment usually (initially) symptomatic
25
Q

Describe the features of measles in displaced individuals (PART 1)

A
  • Very infectious & potentially fatal
  • Widespread despite vaccination programmes
  • Vaccination led to a 73% drop in measles deaths between 2000 & 2018 worldwide
  • Failure to vaccinate led to increases in the number of cases: 2016: 132,490 cases. 2019: 869,770 cases
26
Q

Describe the features of measles in displaced individuals (PART 2)

A
  • Mortality: 207,500 measles deaths globally in 2019*. >95% in low-income countries. mostly children <5Y
  • Common in crowded emergency settings, large population displacements & high levels of malnutrition.
  • Worst single killer of children in some refugee situations
  • Vaccination & Vitamin A are vital components of initial control measures
27
Q

Describe the features of malaria

A
  • Caused by protozoan parasites, Plasmodium spp.
    • Transmitted by female Anopheles mosquitoes
    • Widespread in tropical & subtropical regions
  • ca. 3.5 billion people at risk
  • 249 million cases of malaria in 2022
  • 228 million in Africa (95%)
  • ca. 608,000 deaths from malaria in 2022: 95% in Africa, ca. 78% children <5Y
  • Vector control, protective measures, treatment
28
Q

State the correlation between Malaria and Disasters

A

Many countries affected by natural disasters or armed conflict are in malaria endemic areas

29
Q

Describe the long term problems of TB & HIV/AIDS

A
  • Not acute short term problems
  • Potential long term problems
  • Risks of transmission due to: Overcrowding, Poor conditions, malnutrition, breakdown of social networks, economic vulnerability, sexual violence, Risks to aid workers
  • Difficult to treat in mobile (e.g.
    refugee/IDP) populations
  • Incomplete treatment risks development of
    resistance
30
Q

How can diseases be the cause of disasters?

A
  • An important factor in the past
  • Black death began 1348: Probably reduced the world’s population by 20% by 1400
  • 1918-20 “Spanish” flu may have killed up to 100
    million people (5% of the world’s population)
  • Remain so now: Ebola, Covid-19, HIV/AIDS
31
Q

How can we mitigate through diseases caused by disasters?

A
  • aware of risks
  • Aware of & can undertake preventive measures
  • Non-pharmaceutical actions
  • Testing, tracing & surveillance
  • Good treatment methods: intensive care, development of drugs & vaccines
  • Improved diagnostics
32
Q

List some control measures that we can take towards communicable diseases

A
  • Rapid Assessment
  • Prevention
  • Surveillance
  • Outbreak control
  • Disease management
33
Q

How can we carry out rapid assessment as a control measure towards communicable diseases?

A
  • Identify the communicable disease threats faced by the population affected by a disaster
  • Define the health status of the population
  • Detect outbreaks
  • Determine the ability of the population & the responding agencies to control the various diseases
  • Determine needs
34
Q

How can we carry out prevention as a control measure towards communicable diseases?

A
  • Maintain a healthy environment & good living conditions
  • Ensure a good nutritional status
  • Introduce measures to:
  • prevent person to person spread
  • control vectors
  • prevent contact with vectors
  • prevent spread via the environment
  • Public health education programmes
  • Vaccination
35
Q

How can we carry out Surveillance as a control measure towards communicable diseases?

A
  • Set up or strengthen surveillance programmes with early warning mechanisms to:
  • Ensure early reporting of cases
  • Monitor disease trends
  • Facilitate prompt detection & response
  • Assessment of response
36
Q

How can we control outbreaks as a control measure against communicable diseases

A
  • Preparedness: Stockpiles, Treatment protocols! Training
  • Rapid detection
  • Rapid response: Investigation, Confirmation, Treatment, Implement controls
37
Q

How can we carry out disease management as a control measure against communicable diseases?

A
  • Prompt and accurate diagnosis: Syndromic! Laboratory
  • Case definitions
  • Treatment: Stockpiles, Effective treatment, Standard protocols, Training

Conflict And Catastrophe Medicine (34 decks)

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