The struggle for health after cyclone Sidr in Bangladesh
Kayvan Bozorgmehr gives an account of his experiences following Cyclone Sidr in Southern Bangladesh where he was working with the Bangladeshi NGO, Gonoshasthaya Kendra
The devestation in Kakchira village, Patharghata District
On 10th November the International People’s Health University of the People’s Health Movement took place in Savar, Dhaka in the North of Banagladesh. On the campus of the local NGO Gonoshasthaya Kendra (GK- Gonoshasthaya Kendra- People’s Health Centre is a Bangladeshi NGO founded in 1971, which provides people-oriented health management, primary education and women’s empowerment programmes), more than 40 health professionals, activists and scientists from 15 different nations came together to discuss and exchange their experience on the social, political and economical determinants of health.
Five days later Cyclone Sidr threw a shadow over the country. In Dhaka, telecommunication, internet services and electricity supply broke down. Government officials were unable to provide the number of casualties in the worst affected areas, but with every passing day, news about the vast impact of the cyclone emerged. While international donors made the first financial comittments to the Government of Bangladesh, the stunts of US helicopters at the Bay of Bengal dominated the media - we were observers of a CNN-effect just being launched.
Another scene from Kakchira Village
I joined Dr. Rezaul Haque, the Rural Health Coordinator of GK on his assessment mission to the South in order to get an impression of the impact of the disaster on public health, the needs of the people and the coordination of the humanitarian relief. While the public health consequences associated with tropical cyclones include many factors like storm-related mortality, injury, infectious diseases, psychosocial effects, displacement and homelessness, damage to the health-care infrastructure, disruption of public health services, transformation of ecosystems, social dislocation, loss of jobs and livelihood, and economic crisis (1), it is known that these outcomes disproportionately befall developing nations, with human factors strongly influencing the observed disparities. (2)
It was too early to assess the economical losses, but I had the feeling that this disaster combined with its counterpart of extreme poverty, international debts and corruption was going to increase the sufferings of millions of affected people for a long time - especially as Sidr affected areas are surplus areas for production of rice to feed Bangladesh. (3) Despite some success in cushioning exreme poverty to a limited extent in rural Bangladesh, the process of poverty reduction in such Bangladesh is always fragile and the livelihoods of rural areas are fraught with vulnerability that stems from a variety of factors, ranging from natural to social arenas and macro to micro levels - like floods, economic shocks, death and illness in the household, insecurity of life and property - all these and other factors can offset the gains in the poverty frontier. (4)
On day 8 after the cyclone, we headed for the south with a public bus from the Saidabad bus terminal in Dhaka - with generic antibiotics and other essential drugs on the roof of our bus. At that moment GK had 10 doctors and approximately 40 paramedics in the Southern regions, who were already providing health care services.
After two hours we reached the river Padma. The stream, which springs from the Himalaya and the Ganges, carried us on a ferry towards the Bay of Bengal passing a beautiful landscape. Two more hours passed until we left the ferry and continued our ride on the bus. We crossed the river Payra with a second ferry and reached a stoney, torn road, on which we continued our trip. We followed the track of devastation, passed thousands of broken trees and power poles bent like blades of grass. Finally we reached our destination after 10 shaking hours - the subdistrict Patharghata in the district Barguna.
Mr. Selam Khan, the UP Officer of Patharghata and the authority in charge for the subdistrict, was responsible for the coordination of the support in the seven unions of the subdistrict and for the communication with the 20 NGOs, which worked in these areas. He explained the comprehensive Cyclone Preparedness Programme (CPP) provided by the Ministry of Disaster Management and Relief and the Bangladesh Red Crescent Society, while Dr. Haque informed him about the intentions of GK in the nearer future.
According to Mr Khan, “As one of the worst affected areas, Pathargatha has been hit by the eye of the cyclone with a speed of 220 miles per hour for a duration of 3 to 5 hours, accompagnied by a tidal wave with the height of 15-17 feet (approx. 5meters). 95 % of the houses, a total number of 35.700, are lost. 283 people died, 205 are still missing. 36.000 livestock have been killed. 190 educational buildings, 626 kilometers of road and 39 bridges are destroyed. There has been a warning 48 hours before the disaster, so we succeeded to evacuate 24.000 people - but many refused to be evacuated.”
The death toll of Sidr was relatively low compared to the 1991 Bangladesh Cyclone, one of the deadliest tropical storms on record that killed nearly 140.000 people. (5) Sidr was not less severe than the 1991 Bangladesh Cyclone, but due to preventive actions of the government and local NGOs, the building of cyclone shelters and embankments, and the appropriate action of evaquating 1.5 million people of an estimated 5 million people in the costal areas, the death toll could be reduced this time.
Apparently lessons learned from previous cyclones, namely that the risk of dying was related to the type of shelter (6) and that easy access to shelters was a significant factor in reducing the risk of dying (7) had led to an emphasise on preventive actions. But we noted, that there is still a lack of shelters, especially of multifunctional ones. In the whole subdistrict of Patharghata, an area of 387 km², there were only two official cyclone shelters - for many people too far to reach. Mr. Khan agreed with us that additional shelters for animals could increase the willingness of people to be evacuated as that would decrease the loss of livestock - a loss which can impoverish a whole family.
Among the 20 NGOs, only one was dealing with mental health problems. The lack of awareness of mental health problems after disasters may lead to delays in the psychosocial rehabilitation (8) or even to Post Traumatic Stress Disorder among the survivors. The impact of Sidr on the psychological status of the people revealed itself, when we strolled through destroyed villages in Kakchira, Bodma, Horinghata and Djintola and talked to desperate people, each with individual stories of beloved, but lost family members.
We also saw the effects of well-intentioned but poorly implemented aid: for example youngsters from Dhaka throwing clothings randomely from the roof of a building towards a crowd, creating scenes of fighting women and screaming children. There was also a camp organised by a leading NGO, with the capacity to supply 200 children with food for one day over a period of one month. But how can you pick 200 children out of the many in need for help? The information about the camp had been announced in the few schools which had outlasted the cyclone. Lots of children had walked many kilometers to reach the place. I remembered a scene from Bodma, a fishing village in 11 kilometers distance: a 4 year aged child with a spoon in his small hands scratching out a green coconut and feeding the last bits of the precious coconut-flesh to his crying brother with ascites, who was younger than himself. I wondered if those children, who could walk such a distance were those in most urgent need of help. And what about newborns and infants? Among 200 hundred children there were only 8 newborns, all carried by their brothers or sisters - parents or mothers were not allowed to stay in the camp. There were no sanitation facilities for the 200 children.
The medical support and food distribution in the areas we visited was disproportionate. While the international NGOs mainly concentrated on central areas, they were underrepresented in remote areas and duplication of aid occured more than once - despite the CPP and the general effort of the NGOs to coordinate and to cooperate with the governement. In general, the governmental primary health care stations were very poor equiped - a few antibiotics, some paracetamol, some waterpurification tablets. The GK teams and other NGOs were fairly better equiped. But still there was a lack of many things, e.g. gloves for the staff, simple surgical instruments, local anaesthetics and tetanus vaccines in some NGO camps.
I met Zaman, a young doctor of GK. He had reached the affected areas as one of the first teams and had been working in remote areas for the last 8 days. He described the situations he had faced shortly after arriving, the dead bodies, the seperated hands and limbs lying around in the villages, unpassable roads and severe fractures. He said that the main problems now were diarrhoea, pneumonias, colds and fever, and major water and sanitation problems.” In fact all the 451 ponds in the subdistrict used for drinking water were damaged.
Dr. Amal Chandra Roy, the Union Health and Family Planning Officer, was in charge for the coordination of health and medical supply for all the seven unions in the subdistrict Patharghata. By the light of a lantern, we sat in his office, a small room of the only hospital in an area of 387 km² with a total sum of 31 beds. 18 doctors of the government were working in this area since the disaster happened - 18 doctors for an estimated population of 162.000 people. “That is almost one for 10.000 people”, he told us. “Before the disaster there were only two doctors in the whole area, this is a 9-fold increase”. He would appreciate a better cooperation with NGOs, especially with international ones, to avoid duplication.
Experiences from 1991 show, that in the post-cyclone period, the affected areas actually received a much higher level of health-services than they had ever before. Nevertheless, 6 months after the cyclone 1991, there was a significant rise in the prevalence of severe malnutrition in the affected areas for children aged 1-5. This suggests that there were deficiencies in the post-cyclone medium to long term health response. (9) This is the time when the international and national media coverage of the rehabilitation process usually fades - and with them the CNN-effect of pulsative aid, leaving behind the need of sustainable aid to turn relief into self-relience. There is a urgent need to solve not only disaster related problems, but also longterm, global problems - the manmade parts of natural disasters.
I left Dr. Roy’s office and stepped into the room next door, the emergency room of that hospital, where a paramedic sewed an injury close to a man’s eye by the pale light of a candle while a doctor, one of the eighteen, examined a crying child. “We are used to this darkness”, he said.
Kayvan Bozorgmehr
Globalisation and Health Initiative (GandHI)
German Medical Students’Association
bozorgme@stud.uni-frankfurt.de
(1) Shultz JM, Russell J, Espinel Z. Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development. Epidemiol Rev. 2005;27:21-35
(2) United Nations Development Programme. Reducing disaster risk: a challenge for development. New York, NY: John S. Swift Company, 2004
(3) Emergency Response Programme of Gonoshasthaya Kendra : SIDR - 2007. Available from: http://www.medico-international.de/projekte/bangladesh/nothilfe_sidr_2007.pdf
(4) Islam Aminul S. Overcoming Poverty in Bangladesh: Search for a New Paradigm. Bangladesh e-Journal of Sociology. Volume 1. Number 2. July 2004.
(5) http://en.wikipedia.org/wiki/1991_Bangladesh_cyclone
(6) Bern C et al. Risk factors for mortality in the Bangladesh cyclone of 1991. Bull World Health Organ. 1993;71(1):73-8 Avaiable at: http://whqlibdoc.who.int/bulletin/1993/Vol71-No1/bulletin_1993_71(1)_73-78.pdf
(7) Siddique AK, Eusof A. Cyclone deaths in Bangladesh, May 1985: who was at risk. Trop Geogr Med. 1987 Jan;39(1):3-8.
(8) Choudhury WA, Quraishi FA, Haque Z. Mental health and psychosocial aspects of disaster preparedness in Bangladesh. Int Rev Psychiatry. 2006 Dec;18(6):529-35.
(9) Rahman MO, Bennish M. Health related response to natural disasters: The case of the Bangladesh Cyclone of 1991. Soc Sci Med. 1993 Apr;36(7):903-14
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