Dr. Shyam P Lohani

Floods are the most common natural disaster affecting millions of people worldwide every year. Nepal, owing to her topography, is one of the countries prone to natural disasters such as floods and landslides. The torrential rains that caused massive floods in many parts of the country recently have caused enormous damage. But the rainy season has just started. It means that the country is likely to face more floods and landslides during this monsoon. Floods cause huge losses to lives, properties, livelihood systems, infrastructure, as well as public health systems. Along with the other disaster relief activities, it is important to give emphasis on preventive health-related activities during the time of flood and afterward.

Harms
Floods pose immediate dangers to human health, but also cause long-term effects resulting from displacement and worsened living conditions. The impact of flood disasters is expected to grow in the future owing to the effects of climate change and population shifts. The main reasons of floods in Nepal are due to high-intensity rain in a short duration, the poor drainage system in areas frequently affected by floods, and inadequate flood protection structures. Those affected by floods are at higher risk of getting infected with water-borne diseases that are contracted through direct contact with polluted waters. Floods provide excellent breeding site for mosquitoes, which also transmit many vector-borne diseases.
Natural calamities cannot be prevented but the impact of which can greatly be reduced. Our emphasis should be focused on early warning systems and risk management rather than only disaster response. The public health measures should be continued well after the effects of disaster recede. Thus, it is important to develop a robust public health mitigation plan during and after a disaster. The comprehensive risk management should not only include early warning system but also public health protection during and after immediate response, recovery, and rehabilitative phase.
Natural disasters such as flood not only pose immediate dangers to human health but also long-term effects resulting from displacement and worsened living conditions. The immediate health impacts due to floods are drowning, injuries, hypothermia, and animal bites. Conjunctivitis, dermatitis, wound infections, ear, nose, and throat infections are frequently seen during floods but they are not epidemic-prone. Floods cause destruction of habitat for snakes, forcing them to come out to seek dry places, and oftentimes, they come in close contact with humans resulting in bites. Snakebite cases increase substantially following flooding and during monsoon.
Along with those immediate impacts, the World Health Organisation (WHO) has outlined six diseases that are worth looking out for during floods. Those diseases include both water and vector-borne diseases. The major risks of outbreaks associated with flooding are caused by contamination of drinking water facilities that include typhoid, cholera, leptospirosis, and hepatitis A and E.
Floods also increase the number of vector habitats potential to cause illnesses. Standing water due to heavy rainfall and after flood provides an excellent breeding ground for mosquitoes and is potential to cause infections to disaster-affected population, and emergency health workers. Infections such as malaria, dengue, dengue hemorrhagic fever, and other vector-borne illnesses are commonly seen in those areas. Flooding initially flushes out the breeding ground but after the water recedes; it comes back with the potential to cause infection of epidemic proportion.
The malaria epidemic is a well-known post-flood phenomenon in malaria-endemic areas worldwide. The risk of outbreaks greatly increases with the change in behaviour such as sleeping outside, temporary suspension of disease control activities, and overcrowding. Like any natural disaster, flooding may cause an effect on people’s mental health. Oftentimes, people are unable to cope with the situation and may develop mental health problems. Fear, anxiety, and depression are the most common symptoms among people in flood-affected areas.

Response
The rapid response includes arrangements of temporary shelters, food, safe drinking water, and immediate medical help. The public health focus should be directed to prevent water and vector-borne diseases. Uninterrupted supply of safe drinking water is the most important measure to be taken during and after flooding in order to reduce water-borne infections. Chlorination of water is the process of adding chlorine to water for disinfection and making water potable. Drinking clean water and frequent hand washing are measures to reduce the incidence of water-borne diseases.
The risk of vector-borne diseases can be reduced by preventing mosquito bites. The use of mosquito nets and insect repellents or through mosquito control measures such as spraying insecticides and draining standing water will greatly reduce the incidence of vector-borne diseases. Children and elderly people are at high risk of hypothermia. Appropriate clothing should be provided to flood-affected people in order to reduce hypothermia among susceptible populations.
Psychological first aid is an important part of a comprehensive disaster response plan and should be provided by trained health workers, teachers, and community leaders. However, appropriate referral to psychiatrists or psychologists is needed in many complicated cases. Preventive measures against snake bites should also be promoted in areas prone to flooding. It is, therefore, important to have a comprehensive response plan that includes both immediate response and long-term action to tackle any natural disaster.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)