Post Flood Management

Jammu and Kashmir faces a massive natural calamity in the form of flood in which many lives have been lost and there has been widespread destruction of property. The biggest problem now is neither loss of property or of people who have left for good but of the threat of epidemic for its 12 lakh people in Srinagar. As water continues to remain stagnant even more than two weeks, with animal carcasses, human and animal excreta fear an epidemic in the coming days if necessary measures are not taken at the earliest. The water stagnation problem is very serious in flood affected areas and there is a much anticipated fear of diseases such as gastroenteritis, dysentery, typhoid, pneumonia and cholera. The diseases are most likely to affect children and elderly. Floods can potentially increase the transmission of communicable diseases that include Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis ‘A’ as well as Vector-borne diseases, such as malaria, dengue,haemorrhagic fever and plague. Flood water carries away whatever existing on the ground and upstream. Their contact with food items including crops in agricultural lands during flooding can make that food unsafe to eat and hazardous to human health. Power failures caused by floods also damage stored food. Refrigerated and frozen foods are affected during the outage periods, and thus must be carefully monitored and examined prior to consumption. Flooding impairs clean water sources with pollutants and devastates sanitary toilets. The pollutants also saturate into the ground water and/or can infiltrate into sanitary sewer lines through the ground. Some of the problems that are anticipated to be faced by the people of flood hit areassoon after the decrease in water level are discussed ahead of this document.
Water borne diseases
Floodwater is generally contaminated by various pollutants: sewage, human and animal feces, pesticides and insecticides, fertilizers, oil, asbestos, rusting building materials, and so forth.In general, flooding is associated with an increased risk of water-borne diseases. There may be an increased risk of infection of water-borne diseases contracted through direct contact with polluted waters, such as wound infections, dermatitis, conjunctivitis, and ear, nose and throat infections. However, these diseases are not epidemic-prone. The only epidemic-prone infection which can be transmitted directly from contaminated water is leptospirosis, a zoonotic bacterial disease. Transmission occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as sugarcane) or mud contaminated with rodent urine.
Vector borne diseases
Floods may also indirectly lead to an increase in vector-borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster-affected population and emergency workers to infections such as dengue, malaria and West Nile fever. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The risk of outbreaks is greatly increased by complicating factors, such as changes in human behaviour (increased exposure to mosquitoes while sleeping outside, a temporary pause in disease control activities, overcrowding), or changes in the habitat which promote mosquito breeding (landslide, deforestation, river damming, and rerouting).
Infection from corpses
It can be assumed that in Kashmir, many livestock and stray animals are feared drowned in water. Moreover, large quantity of meat and poultry from slaughter houses and shops would also have been flushed away with mighty flood. All this organic waste along with sullage can be source of infection if not mitigated well in time. Another problem is to handle the corpses (dead bodies, usually of human beings). Contrary to common belief, there is no evidence that corpses pose a risk of disease “epidemics” after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV – which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers. However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera). In hepatitis E-endemic areas, outbreaks frequently follow heavy rains and floods; the illness is generally mild and self-limited, but in pregnant women case-fatality rates can reach 25%.Tuberculosis can be acquired if the bacillus is aerosolized. Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid. Gastrointestinal infections are more common as dead bodies commonly leak faeces. The public and emergency workers alike should be duly informed to avoid panic and inappropriate disposal of bodies, and to take adequate precautions in handling the dead.
Patients having chronic diseases
The major trouble in the flood hit areas of J&K is being faced by patients suffering from chronic diseases like diabetes, CVD and nephrological disorders as they require regular medications on daily basis. There is a critical need to transport requisite medicines so as to reach the needy ones failing which emergency conditions or even causalities may occur.
Other problems
Other health risks posed by flooding include drowning and injuries or trauma. Tetanus is not common after injury from flooding, and mass tetanus vaccination programs are not indicated. However, tetanus boosters may be indicated for previously vaccinated people who sustain open wounds or for other injured people depending on their tetanus immunization history. Hypothermia may also be a problem, particularly in children, if trapped in floodwaters for lengthy periods. There may also be an increased risk of respiratory tract infections due to exposure (loss of shelter, exposure to flood waters and rain).
Preventive Measures
As the water recedes in valley, there shall be an immediate need to execute the mitigation measures. WHO recommends various preventive measures against spread of communicable disease risks arising out of floods. Chlorination of water is must to be done in order to reduce the risk of outbreaks of water-borne diseases. It is highly effective against nearly all waterborne pathogens (except Cryptosporidium parvumoocysts and Mycobacteria species). Vaccination against hepatitis A of high-risk groups, such as persons involved in the management of drinking water, waste water or sewage might be considered but not recommended for mass immunization.Malaria prevention can be executed through implementation of indoor residual spraying, or the retreatment/distribution of ITNs in areas where their use is well-known. This will also have an effect on other mosquito-borne diseases. In case of corpses handling, WHO recommendation emphasizes that burial is preferable to cremation in mass causalities and where identification of victims is not possible. The mass management of human remains is often based on the false belief that they represent an epidemic hazard if not buried or burned immediately. Bodies should not be disposed of unceremoniously in mass graves and this does not constitute a public health measure, violates important social norms and can waste scarce resources. For workers that routinely handle corpses it must be ensured that graveyards should be at least 30m from groundwater sources used for drinking water. Surface water from graveyards must not enter inhabited areas. Ensure universal precautions for blood and body fluids.Use of body bags and hand-washing with soap after handling bodies and before eating must be taken care of. Bodies do not need to be disinfected before disposal (except in case of cholera) but vaccination of workers against hepatitis B is highly recommended.
Rescue measures have already been taken up at war footing by NDRF, Forces and local administration in the flood hit regions. Now the thrust area to be focused ahead shall be ensuring adequate relief, rehabilitation and resettlement of the flood victims. Lastly, development or updating of the mental health policy and plan to ensure a long-term vision of strengthening the mental health system in flood hit areas is highly recommended. Establishing community based mental health services to include psychiatric units in general hospitals and special camps can also be established for people who had suffered trauma especially children, elderly and pregnant women.
(The author is lecturer in Environmental Sciences)

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