Health and Nutrition of Children and Women in Disaster Situations: Experience from Pakistan and Sri Lanka

The Tragedy of the Tsunami of 26th December 2004; Health and Nutrition Status of Earthquake-affected Population in Pakistan

Special Session on Health and Nutrition of Children and Women in Disaster Situations: Experience from Pakistan and Sri Lanka from the 8th Commonwealth Congress on Diarrhoea and Malnutrition

The Tragedy of the Tsunami of 26th December 2004

D.G. Harendra de Silva ([email protected])
Department of Paediatrics, Faculty of Medicine, University of Kelaniya,
Thalagolla Road, Ragama, Sri Lanka

The human tragedy of the Tsunami was overwhelming and unbearable not only to the population of the affected countries but also to the whole world. It caught the attention, especially of the Westerners, some who not only were unaware of the geography of small islands like Sri Lanka, but were even unaware of the existence of some affected countries. Within a matter of 10 minutes, hundreds of thousands of people were killed or their dwellings or occupations destroyed. Multiple tragedies of several family members being killed, houses destroyed, and boats or workplaces destroyed were common consequences.

When the Tsunami wave came, people reacted either by fighting the wave or by running away from it (fight or flight). This response either to run or fight is also influenced and modified by one's previous experience. There are also two other possibilities: one is to 'freeze' by fear or 'dissociate' yourself from what is happening which may also be related to previous experience. Initial estimates were tens of thousands of orphans. The most vulnerable to the Tsunami were the elderly and children; women, especially when pregnant, were also vulnerable. Those children who managed to escape were mostly older children or teenagers who managed to grab on to something, usually a tree or a lamp-post. A relatively small younger child population who survived was the ones who were for some reason physically not in an affected area. When a parent or relative grabbed on to the child (although the force of the water and slipperiness dragged many children away from an adult's grasp), some lucky ones survived. A very small number of small kids got thrown on to a higher elevation, such as the roof or a 'Surviving' structure.

Those who died did so instantaneously, while those who survived had only scratches on the bodies and deep scars in their minds. One question asked by the Western media was: "Thousands have been killed and in the midst of the tragedy they still can offer a smile? " The answer was: "Sri Lankans have faced tragedies of war, subversion, mass deaths, and floods, and many families and friends have been affected for more than two decades. They have managed to rise positively soon after each of these disasters. It is this resilience in the community that has made them look forward compared to
a population like the US that feels/felt completely protected and insulated from massive disasters but yet had to face 9/11".

On a negative note, the local and international responses may not have been the most appropriate. There were both international and local 'experts', after reading some manuals for worldwide disasters, giving out inappropriate message by requesting bottled water and, most adversely, infant milk food and feeding bottles! In a country where breastfeeding is a norm, in disaster where infants and young children also died with their mothers, the risk of breastfeeding mothers stopping breastmilk when receiving 'free' bottled milk, and the likelihood of breastmilk subsequently drying up in the midst of poor sanitation in the refugee camps really spelt another disaster of diarrhoea and dysentery. Thousands of packets of prepared food that went to the refugees within a few hours of the disaster were overwhelming and were often too much, and sometimes it had even gone stale. Although there has been criticism of these aspects together the food/goods were inappropriate or stale.

There were some others, including officials, who looted relief rations and medicines. There were politicians who took advantage of the situation, while other politicians may have taken advantage, but did work positively for the benefit of mankind. Two politicians accused of paedophilia took advantage of the situation. One even got bail on false claims. A criticism aimed at those affected was that they were standing in queues to collect more than what they needed. "If there was an excess of dry rations going around, it would be better to be distributed in excess to the people rather than getting into hands of corrupt officials as long as the excesses were not sold or bartered for cigarettes, alcohol, or drugs.

Another major issue was: donor groups wanting to give money for only 'tangible' projects. Projects that could be seen and shown to donors were what most people wanted, like building houses, giving boats, temporary shelter, books, school bags, and uniforms. Another human weakness! When money is raised ad hoc without verifying the real needs (that would take a long time to assess), neither the donors nor the collectors can be blamed! Before any assessments were done and before the actual extent of the tragedy was known, money for orphanages was collected in the West, and now they have to build these orphanages whether it is needed or not. There were many interested parties wanting to adopt possibly to be child servant!?

The media meanwhile did a tremendous job by focusing the tragedy both locally and internationally. However, all over the world, the media wants sensation on any issue and the Tsunami was one of those 'big' ones! When the 'heat' of sensation of the tsunami was waning off, some media persons, including international ones, were trying hard to sensationalize on the 'fall outs' of the Tsunami which could have become really sensational issues.


Health and Nutrition Status of Earthquake-affected Population in Pakistan

S.M. Moazzem Hossain (1), Kevin Sullivan (2), Leah Richardson (3), and Rifat A. Anis (4)
(1)Nutrition Section, Programme Division, United Nations Children's Fund, 3 UN Plaza, 44 St. E., Manhattan, New York, NY 10017, USA, (2) Emory University and Centers for Disease Control and Prevention, Atlanta, Georgia, USA, and (3) Strategy and Programme Support Division, World Food Programme, Rome, Italy, and (4) National Institute of Health, Chakshezad, Islamabad, Pakistan

Background: On 8 October 2005 (Saturday), a strong earthquake, said to be the most powerful (7.6 on Richter scale) in the region in 500 years, killed more than 78,000 people and caused massive destructions, mostly in the northern parts of Pakistan, Upper Northwest Frontier Province (NWFP), and Azad Jammu Kashmir (AJK).

Objective: The study looked at the nutrition status of children aged 6-59 months, their mothers, morbidity, mortality, feeding practices, food consumption, water, sanitation and hygiene practices, and programme coverage of some interventions.

Methodology: Four cross-sectional surveys were conducted during 21 November-26 December 2005 to assess the situation of household residents in Mansehra and Muzaffarabad districts and displaced population of the NWFP and AJK camps. In total, 2,171 households were interviewed in 4 survey areas with a total of 2,442 children aged 6-59 months, and 1,662 mothers were assessed for nutritional status.

Results: Global acute malnutrition was high (10.5%) among the children, aged 6-59 months, of Mansehra district compared to Muzaffarabad district and the NWFP and AJK camps (5.7%, 6.0%, and 4.2% respectively). Chronic malnutrition, indicating a long-term poor nutrition prior to the earthquake, was at high levels in all 4 areas__44.5%, 38.1%, 54.8%, and 44.0% in Mansehra, Muzaffarabad, NWFP camps, and AJK camps respectively. In Mansehra community, the point estimate for the crude-mortality rate (CMR) on the day of the earthquake was 168 deaths per 10,000 population per day. In Muzaffarabad community, it was 506 per 10,000 per day, in the NWFP camps 489 per 10,000 per day, and in the AJK camps 537 per 10,000 per day. The camp population particularly had a very high prevalence of diarrhoea with over half of the population, aged less than 5 years, experiencing diarrhoea in the previous 2 weeks. Dysentery as a sub-set of overall prevalence of diarrhoea was also high. The prevalence of acute respiratory infection in all survey populations was extremely elevated at around 60-75% with no important difference between camps and community populations.

Conclusion: Although the nutrition situation does not indicate a serious crisis, the results should be viewed in the context of the multiple aggravating factors (harsh winter, massive household destruction, high unemployment figures, high morbidity, etc.) existing in the locations at this time.

Acknowledgements: This joint UNICEF/WFP/WHO survey was conducted in collaboration with the National Institute of Health and Nutrition Wing under the Ministry of Health, Government of Pakistan. UNICEF, Pakistan funded the study with logistic support from the World Food Programme. Emory University/CDC helped in data analysis and interpretation of anthropometry and mortality-related variables.