HEALTH EFFECTS OF COASTAL DISASTERS AFTER THE WATER RECEDES

Most disasters produce consistent death and injury patterns. Primary causes stem directly from the event itself and thus vary by event type, e.g., drowning in tropical storms and floods, injury and drowning in tsunamis. Secondary causes are driven by common effects regardless of event type: loss of electrical power and shelter, transportation disruption, loss of healthcare access, attempted repair/restoration, and other disruption of daily routine. Cause of death may be difficult to attribute, typically leading to undercounting. Secondary causes of death, illness, and injury can be divided into four broad categories: pre-existing medical conditions, environmental degradation or magnified exposure, secondary trauma, and psychological effects. All of these relate not only to post-impact outcomes but also may affect primary event survival.

Pre-existing medical conditions include common non-communicable diseases that are typically medication-controlled (e.g., cardiorespiratory, diabetic, and psychological disorders) and/or rely on recurring outpatient procedures (e.g., hemodialysis for end-stage renal disease); some conditions require home oxygen administration, powered life-support equipment, or other adjuncts. All categories rely on maintenance care, lack of which turns a chronic, relatively stable condition into an acute one at the worst possible time. Environmental causes include unmediated exposure to ambient environment, degraded air and water quality (including otherwise-controlled infectious diseases), and introduced toxicants, particularly carbon monoxide. Secondary trauma includes motor-vehicle collisions, electrocution, and other injuries, particularly those related to repair and short-term recovery. Psychological causes, beyond preexisting conditions, include disrupted routine and lifelines and extended effects (e.g., prolonged disruption, personal loss, subsequent events).

Most secondary health effects are recurrent and thus predictable well in advance of an incident. Even if they can’t be prevented in entirety they can be lessened by awareness and deliberate action on the part of governments, institutions, support services, and individuals, including more realistic assumptions, expanded insurance coverage, and refocused preparedness campaigns.