Preventive Medicine in Humanitarian Emergencies

5.1. Public Health Priorities

The objective of post-disaster health interventions is to minimize death and prevent excess disease. Another public health priority is to facilitate community preparation for future disasters. Ideally, all interventions are guided by a thorough emergency needs assessment and ongoing evaluation of the team’s effectiveness during a disaster situation.

Among the survivors of the immediate inciting event, the leading causes of morbidity in disasters typically are diarrhea and acute respiratory infections

Immediate public health interventions include the following priorities:

• Provide safe drinking water
• Control human waste
• Protect food supply
• Vector control
• Provide adequate shelter

Provide Safe Drinking Water

Providing sufficient quantities of clean drinking water is usually the highest priority of all disaster relief efforts. Effective water purification programs will likely have a greater impact on community death and disease rates than any other single intervention. To be effective, drinking water programs must be accepted by the community, so factors such as taste and convenient access to the purified water source must be taken into account. For long-term planning, water purification programs must be sustainable by the community once the disaster is under control.

Simple field treatment of water may improve quality and decrease waterborne infections. Covering and allowing sediments to settle will improve the quality and decrease amount of chlorination needed to purify water. Sand filtration by allowing water to percolate through stones and sand contained in a 55 gallon barrel will also improve quality of water. Bulk chlorination, when available, is another way to provide clean water to large numbers of people. Reverse osmosis units, such as those used by military, can provide thousands of gallons of pure water but are expensive, require expertise to operate, and take many days to deliver to a community, costing valuable time.

Boiling takes time and effort. Cleaning water by adding bleach or chlorine at the household level relies upon motivation, efficient distribution of cleansing products, and most important, a fair amount of education to do it correctly.

Utilizing an effective distribution system is equally important as having clean water. No matter the quality of water at the source, it must arrive to the end users in some fashion. Clean, covered storage tanks are a top priority as well as a means to transport the water to community members.

Control Human Waste

It is best to use a family-centered approach to establishing portable lavatories.

Take into account the special needs of children when planning for community sanitation programs. Children are more likely to defecate indiscriminately and may not use a portable lavatory that is inconveniently located, frightening, or does not meet their physical needs. Soap and water for personal hygiene are a lower priority when compared with drinking water supply and the elimination of feces. However, after drinking water requirements have been covered, it will be important to provide soap and water for personal hygiene to prevent the spread of infectious diseases. A minimum of 7 liters of water per person daily is needed for covering hygiene requirements.

Protect Food Supply

Developing a plan for protecting the food supply should occur in disaster preparedness. Securing community resources and safely storing and protecting emergency rations are important details to work out in advance and should include all key agencies involved with disaster planning. Protecting food preparation from contamination is a high priority. Basic measures for preventing food-borne illness include:

• Using drinking water for food preparation
• Strict hand washing by food handlers
• Keeping food preparation areas and utensils as clean as possible
• Control of flies and other vectors
• Proper cooking, storage and serving techniques.

Additionally, providing health ­education information may be necessary to help community members prepare and use food resources safely.

Provide Adequate Shelter

WHO recommends at least 4 square meters of floor space for each person in an emergency shelter. Shelters are more effective if they keep families and other traditional community groups together and are close to resources such as food, water, lavatories, medical care, and transportation. When homes are destroyed, it is far better to locate shelters as close to or within the pre-existing community whenever possible.