Post-Earthquake Health Problems

In addition to many grievances after the earthquake disaster that caused great destruction in our country on February 6, 2023, the health problems that the local people may experience and the precautions to be taken.

Earthquakes have caused 780,000 deaths in the last century. In addition, the Tsunami disaster took 200,000 lives in the last century. Apart from direct deaths from disasters, deaths from other health causes account for a significant ratio of 1:3. These include acute liver damage and diseases, spleen damage, pelvic damage, subdural (brain) damage and bleeding, sepsis that manifests itself within days and weeks after the earthquake, multiorgan damage, and wound infections. In addition, earthquake victims with chronic diseases such as diabetes, heart failure, and kidney failure are at risk of death because their medical treatments cannot continue. Among those who stayed under the rubble for a long time, 14-18% were rescued with kidney failure. At this stage, sodium potassium electrolyte levels are dangerous and even if they are normal, fluid resuscitation (support) should be applied quickly, and this fluid should not contain potassium and calcium since the person’s ion levels have already increased. Tetanus also covers a significant proportion of these problems. In people with injuries, necrotic tissue and damaged skin create an environment for bacteria due to lack of nutrition. All these health problems are called Crush Syndrome.

People with problems such as contusions and fractures have a high rate of abnormally elevated clotting problems (Disseminated Intravascular Coagulation, DIC), sepsis, and adult respiratory distress syndrome.

Apart from this, approximately 35% of heart attacks, arrhythmias, and systolic and diastolic blood pressure increases are observed.

Additionally, posttraumatic stress, mental problems, depression, and suicidal tendencies are also seen among survivors.

Children experience more injuries and other health problems than adults.

Health problems in earthquakes can be divided into three phases;

Phase I health issues:

Sepsis: Sepsis is a condition that occurs when the immune system responds violently to an infection. It is characterized by high fever, rapid heartbeat, difficulty breathing, and convulsion. They are more likely to be seen in children, the elderly and people with weak immunity. If the bacteria that causes sepsis enters the blood, the reaction is more severe and is called septicemia. As sepsis progresses, a condition called septic shock occurs. In this case, the person must be given oxygen immediately, his/her breathing needs to be facilitated, the damaged tissue must be removed surgically, and if it is thought to be a bacterial shock, high doses of antibiotics must be given.

Bone fractures: Serious body damage seen during an earthquake. Bone can break in two ways. These can be divided into complete or partial fracture. In addition, if the broken bone damages tissue or skin, it can be considered as a combined damage, but if it only breaks and does not damage the tissue, this can be considered as a closed fracture. Combination damage is the most dangerous here.

Heart Attack (MI): Unlike cardiac arrest, heart attack manifests itself with symptoms such as a feeling of pressure and pain in the chest radiating to the arms, nausea, vomiting and sweating. Cardiac arrest is the stopping of the heart. Cardiac arrest can happen suddenly, without symptoms. The patient gives no reaction and cannot breathe. The patient should receive immediate cardiopulmonary resuscitation (CPR). If the patient is not breathing but is trying to do so, start with CPR. (fingers are interlocked with the hands on top of each other and the middle of the rib cage is pressed from a height of at least 5 cm, approximately 100 times per minute. Before each pressure, the chest should be waited to become normal). This should be continued for a while even if the patient begins to breathe. A defibrillator should be used when medical help arrives.

Phase II Health problems:

The biggest risk after an earthquake is protecting survivors from various infections. These first days are the period of taking precautions against contamination caused by earthquake damage, from 4 days to 4 weeks after the emergency health aid. These are infections caused by air, food and water.

Phase III Health Problems:

It is the period 4 weeks after the earthquake. This phase is the period of clinical emergence and contagiousness of infections with a long incubation period. These also manifest themselves in various ways.

a- Diseases that cause diarrhea: These are generally water-borne. Such problems now constitute 40% of those living in camp environments. Contamination of water during transportation and sharing of fecally contaminated water causes serious epidemic problems. The infection called leptospirosis is the most serious of these.

b- Infectious diseases that can be transmitted from the bodies of deceased people: In this regard, when decomposition begins, invading organisms can no longer survive, so they are not as serious as waterborne infections.

Cholera, typhoid and hemorrhagic fever epidemics are excluded. Therefore, after burying their loved ones, survivors should not stay in the places where their lost relatives are buried for a long time.

c- Infectious diseases that may occur through the respiratory tract (Acure Respiratory System Diseases): These may be Influenza, Covid, Meningitis, Tuberculosis and Scabies (scabies), Measles, Malaria, AIDS diseases. These diseases may arise from stuffy indoor environments where many people breathe the same air and use the same beds.

As precautions, keeping distance between tents, storing food correctly, disposing of garbage correctly, vaccination, control of drinking and utility water, and raising public awareness are important steps in preventing the health problems that may occur above.

The table below summarizes possible health problems and preventive measures (taken from Source 2);

Not enought feedingTuberculosis, Measles, Acute Respiratory infectionsVaccinationMeasles, Meningitis, Yellow Fever, Japanese Encephalitis, Diphtheriacarrier controlMalaria, Leishmaniasis, Dengue Fever, Japanese Encephalitis, Yellow fever, other hemorrhagic febrile diseasesPersonal protection Malaria, leishmaniasisMalaria, Dengue Fever, Oriental Boil (mosquito net used with insecticide)personal hygieneLice-borne diseases: Typhoid, Depressive Fever, Trench FeverHealth EducationSexually transmitted diseases, HIV/AIDS, Diarrheal diseasesIsolation of epidemic diseasesCholera, Dysentery, Tuberculosis, Acute Respiratory infections, Malaria, Fever, Hemorrhagic fever, Meningitis, Typhoid

Not enought feedingTuberculosis, Measles, Acute Respiratory infectionsVaccinationMeasles, Meningitis, Yellow Fever, Japanese Encephalitis, Diphtheriacarrier controlMalaria, Leishmaniasis, Dengue Fever, Japanese Encephalitis, Yellow fever, other hemorrhagic febrile diseasesPersonal protection Malaria, leishmaniasisMalaria, Dengue Fever, Oriental Boil (mosquito net used with insecticide)personal hygieneLice-borne diseases: Typhoid, Depressive Fever, Trench FeverHealth EducationSexually transmitted diseases, HIV/AIDS, Diarrheal diseasesIsolation of epidemic diseasesCholera, Dysentery, Tuberculosis, Acute Respiratory infections, Malaria, Fever, Hemorrhagic fever, Meningitis, Typhoid

Not enought feedingTuberculosis, Measles, Acute Respiratory infectionsVaccinationMeasles, Meningitis, Yellow Fever, Japanese Encephalitis, Diphtheriacarrier controlMalaria, Leishmaniasis, Dengue Fever, Japanese Encephalitis, Yellow fever, other hemorrhagic febrile diseasesPersonal protection Malaria, leishmaniasisMalaria, Dengue Fever, Oriental Boil (mosquito net used with insecticide)personal hygieneLice-borne diseases: Typhoid, Depressive Fever, Trench FeverHealth EducationSexually transmitted diseases, HIV/AIDS, Diarrheal diseasesIsolation of epidemic diseasesCholera, Dysentery, Tuberculosis, Acute Respiratory infections, Malaria, Fever, Hemorrhagic fever, Meningitis, Typhoid

Clean water Diseases that develop diarrhea, typhoid, Guinea worm
good sanitation Diseases that cause diarrhea, carrier-borne diseases, scabies
Not enought feeding Tuberculosis, Measles, Acute Respiratory infections
Vaccination Measles, Meningitis, Yellow Fever, Japanese Encephalitis, Diphtheria
carrier control Malaria, Leishmaniasis, Dengue Fever, Japanese Encephalitis, Yellow fever, other hemorrhagic febrile diseases
Personal protection Malaria, leishmaniasis Malaria, Dengue Fever, Oriental Boil (mosquito net used with insecticide)
personal hygiene Lice-borne diseases: Typhoid, Depressive Fever, Trench Fever
Health Education Sexually transmitted diseases, HIV/AIDS, Diarrheal diseases
Isolation of epidemic diseases Cholera, Dysentery, Tuberculosis, Acute Respiratory infections, Malaria, Fever, Hemorrhagic fever, Meningitis, Typhoid

WHO: Communicable Disease Control in Emergencies: A Field Manual: ISBN 92 4 154616 6.,WHO /CDS/2005

Connolly MA, Gayer M, Ryan MJ, et al. Communicable diseases in complex emergencies: impact and challenges. Lancet, 2004;364:1974-1983

Kouadio Koffi Isidore, Syed Aljunid, Taro Kamigaki, Karen Hammad and Hitoshi Oshitani: Preventing and controlling infectious diseases after natural disasters. United Nations University Articles.13 March,2012.