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In this feature article, Maddy Wright and Ankur Gupta explore the challenges faced in South Asia three months on from the devastating earthquake.

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South Asia Earthquake: the ongoing health challenges

Following the earthquake on Oct 8th in northern Pakistan, the crisis is far from over. After the initial devastation, there remains enormous threat of a ‘disaster within a disaster’. In addition to the common problems in the aftermath of a natural disaster, such as trauma, water, sanitation and communicable disease, Pakistan faces some larger health challenges. Many of these are specific to the climate and terrain of the region affected, and further complicate the inevitable consequences of any emergency of this scale.1

The strong winds and heavy snow have created an environment wrought with dangers for both the residing communities and the relief effort attempting to access them. It became a government priority for those made homeless by the earthquake to have access to ‘winterised’ tents for protection from the extreme weather conditions. As the first snow had fallen before this could be ensured, many of these people are in danger of hypothermia, especially those already weakened by injuries or disease. Thousands have only plastic sheets if anything at all to protect them from the freezing conditions.2

Difficulties for the more remote communities of Pakistan living in the mountainous regions in accessing healthcare have been exacerbated by landslides and the destruction of roads. Many villages are cut off from all supplies of food and aid.3 Large quantities of inappropriate and unnecessary aid have blocked what few roads remain open making the supply of tents and other aid even more difficult.

As well as repairing physical structures damaged in the earthquake, Pakistan also faces the challenge of rebuilding health infrastructures. Photo from Together for Peace Exhibition "Eight Ways to Change the World" www.togetherforpeace.co.uk

Due to the severe conditions and difficulties in access, the Pakistani government has planned to move many of these people from the mountainous regions to the lower terrain and cities. The benefits are questionable in the face of health care and basic needs already overwhelming capacity within the cities and towns. The ethical question of whether agencies should try and provide aid within their own villages or move people to large camps is again being raised, in addition to the practical issues.

There were huge numbers of fatalities among qualified health professionals working in the hospitals and health centres, leaving the health system depleted in its workforce. The WHO is providing essential health kits and appropriate training to more than 200 voluntary community health workers. A total of thirteen medical teams have been mobilised by the ministry of health to reach remote areas, but many of the institutions, even if the buildings are in tact are understaffed.1

Estimated potential prevalence of severe mental health disorders as a result of the earthquake stand at approximately twenty percent of the acutely affected populations. The ministry of health and the WHO developed a National Plan of Action for Mental Health Relief, including strengthening coping skills by normalisation of emotional distress, training existing healthcare staff in psychological support techniques and rebuilding and improving professional psychiatric services.4 However, these interventions rely on the help of the media to create awareness and large amounts of resources to improve existing services, neither of which are available in the affected areas.

Many of the challenges that are facing Pakistan have been seen following other natural disasters, for example the Asian Tsunami of December 2004. The current problems have been exacerbated by early relief efforts concentrating on too few areas, being hampering by inappropriate aid and ignoring the long term sequelae that are now causing greatest public health problems.2

It is important that flaws in early relief efforts are recognised and appropriate policies implemented to prevent future large scale relief efforts making similar mistakes. One such programme is the WHO’s Three Year Plan aiming to strengthen their role in preparing for and responding to crises such as natural disasters. Such programmes, the disease surveillance systems and vaccination programmes along with the coordination of relief and aid finally improving in Pakistan are grounds for cautious optimism.3 However, more resources are needed to prevent many hundreds of thousands needless deaths in the aftermath of the earthquake.

Maddy Wright and Ankur Gupta

1. World Health Organisation. South Asia Earthquake Situation Report #21. Geneva: World Health Organisation, Ministry of Health Pakistan November 2005.
2. Ahmad K. Saving lives in the aftermath of Pakistan's earthquake. Lancet 2005;366(9495):1423-4.
3. The L. A forecast of disaster for Pakistan. Lancet 2005;366(9498):1674.
4. World Health Organisation. Post Disaster Mental Health Relief. Geneva: World Health Organisation, Ministry of Health Pakistan November 2005.