DISASTERS

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DISASTERS AN INDIAN EXPERIENCE

• Prof. Shridhar Sharma
• MD, DPM, FRCPsy (London) FRANZCP(Australia),
  DFAPA (USA), FAMS
• Emeritus Professor
• National Academy of Medical Sciences
• Institute of Human Behaviour Allied Sciences,
  Delhi-110 095

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• Disasters are ubiquitous but most large scale
  disasters occur in cancer and tropic of Capricorn
  geographical region which encompasses most of the
  developing nations.
• Due to the geography and topography, India has
  faced serious large scale natural disasters like
  droughts, cyclones and earthquakes.
• The available statistics also show that the
  number of disasters per year is increasing but
  also the number of people affected and killed is
  also rising.

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Major Disasters in Known History of India
SR. NO. Name of Event Year Fatalities
1. Bengal Earthquake 1737 300,000
2. Bengal Cyclone 1864 60,000
3. The Great Famine of Southern India 1876-1878 5.5 million
4. Maharashtra Cyclone 1882 100,000
5. The Great Indian famine 1896-1897 1.25 million to 10 million
6. Kangra earthquake 1905 20,000
7. Bihar Earthquake 1934 6,000
8. Bengal Cyclone 1970 500,000 (include Pakistan Bangladesh)
9. Drought 1972 200 million people affected
10. Andhra Pradesh Cyclone 1977 10,000
11. Latur Earthquake 1993 7,928 death and 30,000 injured
12. Orissa Super Cyclone 1999 10,000
13. Gujarat Earthquake 2001 25,000
14. Indian Ocean Tsunami 2004 10,749 deaths 5,640 persons missing
15. Kashmir Earthquake 2005 86000 deaths (include Kashmir Pakistan)
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• Natural disasters
• Earthquake India is having a high risk towards
  Earthquakes. More than 58 per cent of Indias
  land area is under threat of moderate to severe
  seismic hazard.
• During the last 20 years, India has experienced
  10 major earthquakes that have resulted in more
  than 35,000 deaths.
• Of the earthquake-prone areas, 12 is prone to
  very severe earthquakes, 18 to severe
  earthquakes and 25 to damageable earthquakes.
• The biggest quakes occur in the Andaman and
  Nicobar Islands, Kutch, Himachal and the
  North-East. The Himalayan regions are
  particularly prone to earthquakes.

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Earthquake in Gujarat
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Earthquake
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• Floods
• About 30 million people are affected annually.
  Floods in the IndoGangeticBrahmaputra plains
  are an annual feature.
• On an average, a few hundred lives are lost,
  millions are rendered homeless and several
  hectares of crops are damaged every year.
• Nearly 75 of the total rainfall occurs over a
  short monsoon season (June September). 40
  million hectares, or 12 of Indian land, is
  considered prone to floods.
• Floods are a perennial phenomenon in at least 5
  states - Assam, Bihar, Orissa , Uttar Pradesh and
  West Bengal.
• On account of climate change, floods have also
  occurred in recent years in areas that are
  normally not flood prone.
• In 2006, drought prone parts of Rajasthan
  experienced floods.
•  

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• Droughts
• Drought is another recurrent phenomenon which
  results in widespread adverse impact on
  vulnerable peoples livelihoods and young
  childrens nutrition status.
• About 50 million people are affected annually by
  drought. Of approximately 90 million hectares of
  rain-fed areas, about 40 million hectares are
  prone to scanty or no rain.
• Although a slow onset emergency, and to an extent
  predictable emergency, drought has caused severe
  suffering in the affected areas in recent years,
  including effects on poverty, hunger, and
  unemployment.

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• Cyclones
• About 8 of the land is vulnerable to cyclones of
  which coastal areas experience two or three
  tropical cyclones of varying intensity each year.
  
• Cyclonic activities on the east coast are more
  severe than on the west coast.
• The Indian continent is considered to be the
  worst cyclone-affected part of the world, as a
  result of low-depth ocean bed topography and coast
  al configuration.
• The principal threat from a cyclone are in the
  form of gales and strong winds torrential rain
  and high tidal waves/storm surges.
• More cyclones occur in the Bay of Bengal than in
  the Arabian Sea and the ratio is approximately
  41.
• An analysis of the frequency of cyclones on the
  east and west coasts of India.

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• Landslide
• In the hilly terrain of India including the
  Himalayas and North East India, landslides have
  been a major and widely spread natural disasters
  that often strike life and property and occupy a
  position of major concern.
• One of the worst tragedies took place at Malpa
  Uttarkhand (UP) on 11th and 17th August 1998 when
  nearly 380 people were killed when massive
  landslides washed away the entire village.

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• Avalanche
• Avalanche are river like speedy flow of snow or
  ice descending from the mountain tops.
• Avalanches are very damaging and cause huge loss
  to life and property.
• In Himalayas, avalanches are common

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Tsunami affected Indian territory
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TSUNAMI
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TSUNAMI
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TSUNAMI
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CHARACTERISTICS OF NATURAL DISASTERS
LOW
SUDDEN
HIGH
LOW

• Earthquakes
• Cyclones
• Floods
• Famine

PREDICTABILITY
SCOPE
ON SET DELAY
INITIAL LETHALITY
HIGH
LOW
SLOW
HIGH
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• The last century has added a new ecological
  dimension to the definition of a disaster.
• We then have newer man made disasters on our
  hands which include chemical Disasters like
  Bhopal Gas Tragedy of 1984, oil spills, air water
  and soil pollution.
• Developing countries have been facing the brunt
  more than the developed ones because they have
  less physical and financial resources.
• India as the second largest populated country
  with 1.2 billion population has a large share of
  all types of disasters.

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• It is virtually impossible to prevent
  most disaster.
• Nevertheless, we can forestall or alleviate many
  of their worst effect by anticipating them and by
  being prepared.
• The greatest number of disasters occur in those
  countries that are already most adversely
  affected by ill-health and poor economic
  conditions.

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• DISASTER is a collective responsibility
  requiring coordinated responses from various
  agencies and all parts of the society.
• Government Agencies
• Urban Development
• Agriculture Food
• Health
• Energy - Power

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DISASTERS PRODUCE SEVERAL TYPES OF TRAUMA. THE
HEALTH CONSEQUENCES FALL INTO VARIOUS CATEGORIES

• STARVATION
• WATER POWER SUPPLY
• UNEMPLOYMENT
• ROADS COMMUNICATION

• DEATH
• DISEASE
• DISABILITY
• DISTRESS
• DISLOCATION
• DISORGANIZATION

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DISASTER TRAUMA
PHYSICAL PSYCHOLOGICAL SOCIO-ECONOMIC
Fractures Burns Injuries Infections Poisoning Depression Grief Anger Guilt Apathy Fears The burn-out syndrome Bizarre behavior Suicide Bereavement Anxiety Alcohol abuse Stress reactions Environmental destruction Unemployment Disorganization Homelessness
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APPROACHES

• Rescue
• Relief
• Rehabilitation
• Follow-up

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• THE PSYCHOLOGICAL RESPONSE TO DISASTER WILL
  DEPEND ON THREE MAIN FACTORS
• THE DISASTER - OCCURRENCE
• MAGNITUDE
• SUDDENNESS
• TYPE
• THE COMMUNITY - LEVEL OF PREPAREDNESS
• - SOCIAL SUPPORT
• LEADERSHIP
• PAST EXPERIENCE
• THE VICTIMS
• AGE

DISASTER
MAGNITUDE
RESPONSE
VICTIM
COMMUNITY
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SPEED DIRECTION ARE KEY ISSUES

• The key issues are
• Quick assessment Immediate response
• Quick Planning Coordination
• Quick Execution or action Desired
  result

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KEY CONCEPTS

1. The target population is primarily normal
2. People do not disintegrate in response to
   disaster.
3. People respond to active interest and concern.

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Traumatized individuals are resistant to seeking
treatment So treatment must be taken to
survivors. Victims of flood, earthquakes and
hurricanes Increased
Prevalence of PTSD Depression which
are risk factors for suicidal thinking
suicide rate increases need for mental
Health support after severe disasters.
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• Morbidity represents a cluster of diseases
  involving more than one target organ.
• Exposure levels are difficult to establish
• Environmental Monitoring may have limitations.
• Biological Monitoring may not be feasible.

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• Community as a Resource
• Need for Joint preparation
• Need to develop
• Single function but develop Joint
  training
• Multidisiplinary service model Joint training
• A chain is as strong as its weakest link

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GUIDELINES

• Crucial rehabilitation process.
• The first objective is to get water, Food,
  Electricity and Sewerage system restored plan
  temporary housing up in a few weeks so that the
  people can move out of the schools.
• Long term housing is essential to use locally
  available material that are suitable for the
  climate and culture.
• Getting people to build their own houses has a
  two-fold purpose.
• It provides the people with an income, it gets
  them involved and interested in the design and
  construction of their houses and this
  participatory approach gets them out of the
  depression and lethargy that follows trauma.

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• There is a need for institutionalization of
  process for learning from experiences obtained
  from Disaster
• Creation of information and Data clearing house
  on Disaster management
• Creating a knowledge centre in each Locality
• Readiness and develop strategies and
  intervention.
• Act on lessons learned from evidence based
  research and practical experience (fire in
  building lift staircases, Drowning.- Safety ships
  tanks- Bhopal Gas tragedy

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Longitudinal analysis of earth quake-victims Facto
r 1 - Fear anxiety-appear earlier and decreased
earlier Factor 2 - Depression Physical symptoms
appeared later stayed longer. Factor 3
- Psychosocial problems gradually decrease as
time passed by
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TABLE COMPONENTS OF CHEMICAL DISASTER
PREPAREDNESS

• PHASE ACTIVITY (BEFORE THE DISASTER)
• 1. Hazards Identification of hazards
• Identification of vulnerabilities.
• Assessment of risk
• 2. Prevention Removal of the hazard
• Selection of alternatives
• Hazard control
• 3. Planning Contingency planning
• mitigation Knowledge of rehabilitation
  methods
• Instituting organizational framework

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TABLE COMPONENTS OF CHEMICAL DISASTER
PREPAREDNESS

• PHASE ACTIVITY (AFTER THE DISASTER)
• Emergency Accurate response
• Speed of Action
• Follow-up Knowledge of chemicals(s)
• Fencing of the accident
• Diagnosis of needs
• Implementation
• Monitoring
• Feedback and adjustment
• Information transfer storage

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Therapeutic approaches in survivors of
Disaster Common Psychiatric response to
Disaster 1. Acute stress Disorder 2. Anxiety,
fear and Panic 3. Depression 4. PTSD 5. Substance
Abuse 6. Somatization Disorders 7. Adjustment
disorder 8. Organic mental disorder, injury,
toxins etc.
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• Mental health personnel constitute a very
  valuable resource.
• They should not only be included in the design of
  a disaster plan but also interacted into the
  disaster response team.
• Mental health care must receive special attention
  and be frequently updated for the population
  living in disaster prone areas.
• A plan must be prepared for all situations.
• In order to help victims in distress, mental
  health specialists must design short and long
  term training programs depending on the level of
  knowledge and skills of the staff, and implement
  them.
• In the immediate aftermath of a disaster, both
  health and relief workers need a quick and
  flexible orientation.
• This training session must be planned before the
  disaster impact.

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• DIMENSIONS OF MENTAL HEALTH
• The field of mental health includes three sets of
  objectives.
• One of these has to do with mentally ill person
  s. For them the objective is the restoration of
  health.
• A second has to do with those people who are
  mentally healthy but who may become ill if they
  are not protected from conditions that are
  conductive to mental illness, which however are
  not the same for every individual. The
  objectives for those persons is prevention.
• The third objective has to do with the upgrading
  of mental health of normal persons, quite apart
  from any question of disease or infirmity. This
  is positive mental health. It consists in the
  protection and development at all levels, of
  human society of secure, affectionate and
  satisfying human relationships and in the
  reduction of hostile tensions in persons and
  groups.

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HOPE INDIA CAN DEAL WITH THE CRISIS

• India had enough experience in dealing with
  natural disasters.
• The lessons that we learnt from the Orissa
  cyclone of 2000, the Gujarat earthquake of 2001
  and other disasters have helped us effect a
  paradigm shift in our approach to disaster
  management proceeding from the conviction that
  development cannot be sustainable unless disaster
  mitigation is built into the development process
  at all levels.

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Strategic Plan

• Need to build a national hub to share and learn
  and to create a critical mass of institutions,
  trainers and trained professionals.

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Every calamity presents an opportunity to equip
themselves to face with greater confidence and
competence, similar challenges in the future.
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• Disasters disrupt progress and destroy the
  outcome of developmental efforts over several
  years, often pushing nations in quest for
  progress back by several decades.
• Thus, efficient reduction of disaster risks,
  rather than mere response to their occurrence,
  has in recent times, received increased attention
  both within India and abroad.
• With a vision to build a safe and disaster
  resilient India, the Government has adopted a
  holistic, proactive, multi-hazard oriented and
  technology driven strategy by promoting a culture
  of prevention, mitigation, preparedness and
  response.

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THANK YOU