What are Disasters and Conflicts

Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Aminat Abolade, Tarina van der Stockt, Kim Jackson, Vidya Acharya, Jess Bell, Olajumoke Ogunleye and Ewa Jaraczewska      

Introduction

Disaster, as defined by the United Nations, is a serious disruption of the functioning of a community or society, which involve widespread human, material, economic or environmental impacts that exceed the ability of the affected community or society to cope using its own resources . Disaster management is how we deal with the human, material, economic or environmental impacts of said disaster, it is the process of how we “prepare for, respond to and learn from the effects of major failures” . Though often caused by nature, disasters can have human origins. According to the International Federation of Red Cross & Red Crescent Societies a disaster occurs when a hazard impacts on vulnerable people. The combination of hazards, vulnerability and inability to reduce the potential negative consequences of risk results in disaster .

(VULNERABILITY+ HAZARD ) / CAPACITY = DISASTER

When we think of disasters, we often automatically think of the phenomenon that has caused them – for example, the earthquake, cyclone, or flood. In reality, though, this event is simply the ‘hazard’ – and the disaster itself is caused by a combination of the hazard, our own exposure to the phenomenon (such as whether we live in the area affected) and our vulnerability to it (how we have prepared or mitigated for it). Natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity.

This article examines the advances in the humanitarian response to public health over the past fifty years and the challenges currently faced in managing natural disasters and armed conflict .

Types of Disaster

Sudden Onset Disasters

According to the International Federation of Red Cross & Red Crescent Societies sudden onset disasters, often termed natural disasters  are naturally occurring physical phenomena caused either by rapid or slow onset events that have immediate impacts on human health and secondary impacts causing further death and suffering. The United Nations Office for Disaster Risk Reduction characterises disasters in relation to their magnitude or intensity, speed of onset, duration and area of extent e.g. earthquakes are of short duration and usually affect a relatively small region whereas droughts are slow to develop and fade away and often affect large regions . These disasters can be as a result of geophysical, hydrological, meteorological or biological. :

Earthquakes

Earthquakes are sudden tremors or vibrations that occur in the Earth’s crust that occur as a result of tectonic plates colliding or trying to slide past each other. This causes a build-up of pressure between the two plates in the Earth’s crust along what is called a fault line. When the plates move at the fault line sudden pressure is released and causes a violent shaking of the earth’s surface in the form of an earthquake.

Earthquakes in particular cause a significant burden of injuries, mainly orthopaedic injuries of the limb with fracture incidence shown to correlate with the Richter Magnitude Scale, where high-energy earthquakes cause more fractures. MacKenzie et al found that fractures accounted for 65% of the total injuries following earthquakes with lower extremities fractures accounting for 59% of those injuries. Bortolin et al found that 10% of fractures involved the pelvic ring, while spinal column fractures accounted for 17% of the total injuries, with more than 4% of these involving spinal cord injury. Many patients also present with crush type injuries that can progress to crush syndrome and compartment syndromes with rhabdomyolysis a common complication. Other injuries seen include amputations, spinal cord injuries and traumatic brain injuries, although numbers seen may depend on a number of additional local factors, including the speed and quality of extraction and the availability of appropriate intensive care and surgical interventions.

Potential Key Issues for Acute Rehabilitation Providers:

• Damage to health infrastructure across a wide area, overwhelming numbers of complex trauma patients, internal displacement creating challenging discharge environments and ongoing risk of aftershocks and secondary disasters, such as landslides.

Tsunamis

A tsunami, meaning 'harbour wave' in Japanese, is most often the result of an underwater earthquake, which creates a very large coastal wave. Generally, the world's largest tsunamis occur at convergent plate boundaries where two tectonic plates crash into each other with the collision forcing one tectonic plate down underneath the other. As this happens the leading edge of the top plate catches on the bottom plate and pressure starts to build, which is eventually released in the form of the most powerful type of earthquake, called a megathrust earthquake. When these megathrust earthquakes occur underwater, a large amount of water is displaced and a tsunami wave occurs.

Tsunamis create a much different context compared to earthquakes and have a much higher mortality ratio of approximately 9 deaths for every 1 injury, with most deaths as a result of drowning. If the tsunami hits an area affected by an earthquake, it is possible that responders have to manage both events simultaneously, creating further challenges. Injury types tend to be made up of mild extremity trauma, including lacerations and also minor fractures but high infection rates are common as a result of delayed care, and challenging discharge environments with continuous exposure to wet and contaminated conditions. Pneumonia is also common following a tsunami, due to aspiration of seawater requiring respiratory assessment and management.

Potential Key Issues for Acute Rehabilitation Providers:

• Damage to health infrastructure in low-lying coastal areas, small surges in complex trauma cases with a high risk of infection, potential respiratory care needs.

Landslides

A landslide is defined as the movement of a mass of rock, debris, or earth down a slope. Landslides are a type of "mass wasting," which denotes any down-slope movement of soil and rock under the direct influence of gravity. The term "landslide" encompasses five modes of slope movement: falls, topples, slides, spreads, and flows. These are further subdivided by the type of geologic material including bedrock, debris, or earth. Debris flows commonly referred to as mudflows or mudslides and rockfalls are the most common landslide types.

Like Tsunami, they have a high death-to-injury ratio (4.5:1) with most deaths a result of suffocation. Typical injuries include lung, thoracic and pelvic injuries with mild bruising and lacerations most common. Research suggests that capacity for physical rehabilitation in landslides may be increased by providing rehabilitation technical skills training to responders and augmenting the emergency response structure with individual rehabilitation specialists and/or teams of rehabilitation professionals’.

Potential Key Issues for Acute Rehabilitation Providers:

• Small surges in complex trauma cases, localised displacement creating challenging discharge environments.

Cyclones

Known as hurricanes, cyclones and typhoons depending on where in the world they appear, these storms typically occur in seasons and with lead times of several days, although their paths can alter, with storm surges in coastal areas particularly dangerous. Although preparedness has the potential to significantly lower mortality and morbidity.

High-income countries account for most of the mortality and morbidity data from cyclones, although most deaths and injuries do result from sequelae such as flooding and landslides rather than directly from the wind. Main reported injuries include contusions and lacerations (particularly to the head and extremities) occurring mainly during strong cyclones where the shelter has been limited with serious injuries such as fractures as low as 1% of all injuries, although a significant proportion of indirect injuries, such as electrocution and burns, occur during clean-up activities.

Potential Key Issues for Acute Rehabilitation Providers:

• Damage to health infrastructure across a wide area, small surges in complex trauma cases, internal displacement creating challenging discharge environments. Possible spikes in infectious diseases.

Floods

Floods are the most frequent type of natural disaster and occur when an overflow of water submerges land that is usually dry, often as a result of heavy rainfall, rapid snowmelt or a storm surge from a tropical cyclone or tsunami in coastal areas. Injuries sustained during floods include orthopaedic injuries, lacerations, hypothermia, electrocution and potentially burns. Infection is a key complication after floods, including cutaneous, respiratory and gastrointestinal infections etc. There are 3 common types of floods:

• Flash Floods - Caused by rapid and excessive rainfall that raises water heights quickly, and rivers, streams, channels or roads may be overtaken.
• River Floods - Caused when consistent rain or snowmelt forces a river to exceed capacity.
• Coastal Floods - Caused by storm surges associated with tropical cyclones and tsunami.
  

Potential Key Issues for Acute Rehabilitation Providers:

• Damage to health infrastructure, small surges in trauma cases with a high risk of infection, internal displacement creating challenging discharge environments, risk of infectious disease outbreaks.

Volcanic Activity

A volcano is an opening in the Earth’s crust that allows magma, ash and gasses to erupt from below the surface. The majority of volcanoes occur at plate boundaries. They can occur where plates separate and or collide resulting in an increase in pressure, which leads to the formation of a magma chamber and in turn a volcano. The eruption occurs when rock from subducted plates melts to form molten magma, which pushes its way towards the surface forming a magma chamber, where the gasses dissolved in the magma expand with a resultant increase in pressure, causing the magma to rise and force its way through cracks/fissures in the volcano above. As it reaches the surface the pressure is released and an eruption occurs during which volcanic ash, rock particles, dust, gasses and lava are all ejected. Hazards from a volcano are not just limited to the local environment (lava flows, pyroclastic flows, mudflows, landslides, debris avalanches or glacial outburst flood) but can also impact areas hundreds and even thousands of kilometres away as a result of ash falls, the release of gases (carbon dioxide, hydrogen chloride, hydrogen fluoride, hydrogen sulphide, sulphur dioxide) and tsunamis, with significant health and economic impacts, although improved early warning .

Potential Key Issues for Acute Rehabilitation Providers:

• Volcanic ash and gas exposure can result in respiratory complications such as asthma attacks, wheeze, cough and respiratory irritation in those with sensitive airways or chronic lung disease, which may be more widespread in large or longer lasting eruptions. Surges in burns and complex traumas may also occur as a result of the initial eruption of debris, lava flows, pyroclastic flows, mudflows, landslides, debris avalanches or glacial outburst flood.

Man-Made Disasters

Man-Made Disasters as viewed by the International Federation of Red Cross & Red Crescent Societies are events that are caused by human activities or choices, which occur in or close to human settlements often as a result of Environmental or Technological Emergencies. This can include :

• Environmental Degradation
• Industrial Pollution
• Accidents (e.g. Industrial, Technological and Transport usually involving the production, use or transport of hazardous materials) 

Complex Emergencies

Some disasters can result from multiple hazards, or, more often, to a complex combination of both natural and man-made causes which involve a break-down of authority, looting and attacks on strategic installations, including conflict situations and war. These can include Food Insecurity, Epidemics / Pandemics, Armed Conflicts, Terrorist Attacks, Displaced Populations

According to ICRC these Complex Emergencies are typically characterized by :

• Extensive Violence
• Displacements of Populations
• Loss of Life
• Widespread Damage to both Societies and Economies
• Need for Large-scale, Humanitarian Assistance across Multiple Agencies
• Political and Military Constraints which impact or prevent Humanitarian Assistance
• Increased Security Risks for Humanitarian Relief Workers

Pandemic Emergencies

Pandemic (from Greek πᾶν pan "all" and δῆμος demos "people") is an epidemic of infectious disease that has spread across a large region, which can occur to the human population or animal population and may affect health and disrupt services leading to economic and social costs. It may be an unusual or unexpected increase in the number of cases of an infectious disease that already exists in a certain region or population or can also refer to the appearance of a significant number of cases of an infectious disease in a region or population that is usually free from that disease. Pandemic Emergencies may occur as a consequence of natural or man-made disasters. These have included the following epidemics/pandemics: Ebola, Zika, Avian Flu, Cholera, Dengue Fever, Malaria, Yellow Fever, Coronavirus Disease (COVID-19)

Armed Conflict

Armed conflicts have marked human existence throughout history and have always caused peaks in mortality and morbidity. Numerous armed conflicts are currently taking place around the world, including those involving warring parties within a single state (non-international armed conflicts) and those involving armed forces from two or more states (international armed conflicts). Alert 2021! Report on Conflicts, Human Rights and Peace-Building highlight 34 armed conflicts during 2020, the same number as the previous year with most concentrated in Africa (15) and Asia (nine), followed by the Middle East (six), Europe (three) and America (one) with two new cases: Ethiopia (Tigray) and Armenia-Azerbaijan (Nagorno Karabakh). More notably 2020 saw a significant increase in high-intensity armed conflicts, which accounted for almost half of the cases, at 47% of the total, although type and impact of conflict vary enormously where weapons can vary from knives and machetes to explosive devices capable of causing massive destruction, death, injury, displacement and suffering on a massive scale. Indirect mortality and morbidity due to destruction of infrastructure (including the specific targeting of health facilities), displacement of people and food and water insecurity is also significant. According to the Armed Conflict Location & Event Data Project (ACLED), as of Quarter 2 2021 alone violence against civilians resulted in over 5,000 deaths worldwide, battle-related deaths numbered over 18,000, explosion/remote violence led to more than 4,000 deaths and riots resulted in over 600 fatalities.

Conflicts are much less predictable than disasters, often with no one single surge of trauma cases but rather peaks and troughs depending on conflict activity. Additional security constraints, including the targeting of health staff, mean that conflict and protracted conflict and their associated displacement of populations make it an extremely complex setting for early rehabilitation provision. Injury mechanisms and the complexity of injuries often require long-term specialist interventions difficult to provide within conflict settings, so for many individuals rehabilitation may only begin once the patient is removed from an area of active fighting, with patients being stabilised and then transferred to safer areas for definitive care, including rehabilitation.

Potential Key Issues for Early Rehabilitation Providers:

• Access to injured people, safety and security, very short hospital admissions for life-saving care only, a breakdown in referral pathways, resource constraints, psychological distress of patients and healthcare staff, long-term rehabilitation uncertainties, movement constraints and population displacement, challenges in identifying patients, ethical challenges, and targeting of health professionals.

Terrorist Attacks

Terrorism is defined in the Oxford Dictionary as “the unlawful use of violence and intimidation, especially against civilians, in the pursuit of political aims.” We quickly see that this definition is unspecific and subjective. The issue of subjectivity, in this case, means that there is no internationally recognised legal definition of terrorism. Despite considerable discussion, the formation of a comprehensive convention against international terrorism by the United Nations has always been impeded by the lack of consensus on a definition. Methods of attack include explosive devices such as car-bombs, suicide bombs or improvised explosive devices (IEDs), close quarter attacks using firearms or blades and chemical, biological, nuclear or radiological (CBNR) devices. As with conflicts, the type of injury and implications for early rehabilitation vary wildly.

Resources

Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion

Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion

What is a Disaster, ICRC