In the wake of a natural disaster

A natural disaster can have a devastating impact on a community or even a country – through causalities, food shortage, water pollution, to damaged roads and medical facilities. All of these can hit the affected areas extremely hard. According to figures from the International Committee of the Red Cross, the earthquakes and aftershocks in Türkiye this February collapsed around 6,000 buildings in the country, making hundreds of thousands of people homeless. This scale of damage would not be fixed overnight. In 2022, after tropical storm Ana hit Malawi, the nation suffered the worst cholera outbreak in its history. Even now, Malawi is still at a risk of a resurgence of cholera from the storm's far-reaching aftermath. In responding to these kinds of disasters, flexibility in adapting to the situations and concerted efforts with different partners are crucial. MSF works in over 70 countries and over 50 years has responded to various kinds of natural disasters. We would like to share with you our experience, as well as people’s testimonies in this issue of Borderline.

Since the start of 2022, Chad has witnessed extreme weather events related to the climate crisis, and they caused severe droughts and erratic rainfall that affected over one million people, according to local health authorities. Along the Chari River, a few meters from the camp for internally displaced people, 25-year-old Soria Sana with her 1-year-old daughter Ahmad washes the pots she uses for cooking. The floods destroyed her house. She was forced to get water from the river to wash clothes and to cook, which raises the risk of being infected by waterborne diseases. 

Although flood water doesn't usually rush in all of a sudden, it does take a long time to recede. People trapped by floods for a long time are forced to live in precarious conditions that lead to different kinds of health problems. In 2021, the flood in Bentiu, South Sudan didn’t recede for 8 months, creating issues like infectious diseases, food insecurity and malnutrition.

Generally, water pollution is the major problem in the aftermath of floods. In May 2023, the situation in many places around Kalehe in the Democratic Republic of Congo was catastrophic following the devastating floods and landslides that hit this area of South Kivu province. Poor living and sanitary conditions in the aftermath of the floods create high risk of health problems, such as skin infections and diarrhea diseases, especially in this area close to the Lake Kivu where cholera is endemic. Our water and sanitation team clean and repair water facilities to address the root cause of these major medical conditions. Providing water trucks, installing water tanks, pumps and filtering system, as well as setting up sewage treatment facilities and building latrines can help the locals improve their water quality. Our teams are also providing medical consultations in unaffected medical facilities and from mobile clinics. Many patients have health problems which are related to contaminated water sources, for example watery diarrhea and skin infections and vector-borne diseases like malaria. We provide treatments to patients and refer them to the hospital for specialty care.

In case of an outbreak, MSF will vaccinate high-risk people like children against common diseases. We also distribute hygiene kits, cooking sets and preventive kits like chlorine tablets (to purify water) and mosquito nets against diseases like malaria, scabies, dysentery and typhoid. Health promotion activities will also be carried out in conjunction with these distributions to guide people on how to best purify water with the available resources.

Justin Tiamaro, 53, walked 8 km to come to the health center in a village in Madagascar to get treatment for his sick boy. MSF set up a moblie clinic there.

Madagascar is one of the countries at most risk from climate change and faces extreme weather events at regular intervals. The southeast region was hit in early 2022 by two consecutive cyclones, Batsirai on the 5th February and Emnati on the 22nd February. They left a trail of destruction to many medical facilities. Justin Tiamaro is one of the victims. MSF emergency responce team had been trying to reach remote rural areas, but that was not an easy task. Cyclones bring rainstorms and strong wind, which cause damages to infrastructure like roads, buildings and power cables. Floods and landslides might also occur after the storm causing further damage, including to medical facilities. Many challenges have to be overcome before we can successfully reach the people living in remote areas.

Lopino, a village in Haiti is one of the many isolated communities severely affected by hurricane Matthew in 2016. “...Lopino, a village in the mountains that can only be reached by helicopter...The streets were lined with fallen trees and debris.” says Dr Danielle Perriault, an MSF doctor who worked there. “Our time in the village was always limited, because the frequent storms during the rainy seasons restrict the helicopter flights. Even when we reached a village by a vehicle, the drive on damaged roads could last more than two hours one way, reducing the time available with patients. So, we had to work as quickly as possible.”

Aside from helicopters, we would use a variety of ways to get to remote areas for medical aid. For example, MSF ran mobile clinics by boat to deliver medical and humanitarian aid to five islands south of Guiuan, Philippines that were affected by Typhoon Haiyan in 2013. The team could treat up to 200 patients per day, doing minor operations on the islands and referring complicated cases to MSF’s hospital in Guiuan.

"We set up wherever there is half a roof, anywhere we can do consultations."

Dr. Mads GEISLER, from Denmark,
arrived in the Philippines one month after the typhoon.

Khaled Mostafa Darwish, 55 from Hama Governorate, Syria. He was living in Antakya, southern Türkiye, with his wife and ten children when the earthquake struck. “I was the first one to get out [from under the rubble]. Well-meaning people gave us a hand. When my son was pulled out [of the rubble], a Syrian doctor told us that he died, while a nurse said that he was still alive. We rushed him to the hospital. I was barefoot for two days. I wasn’t aware that I was not wearing shoes…”

Earthquake for only tens of seconds can cause long term impacts. Health threats due to earthquakes can vary depending on the magnitude of the quake, physical structure of the buildings, and the secondary effects of the earthquake like tsunamis or landslides. Earthquakes can have a range of immediate and long-term impacts on health. Casualties due to collapsed buildings are common, while in the longer term, we see risks of infection for wounds not treated properly, increased morbidity and risks of complications related to pregnancy and childbirth due to interrupted obstetric and neonatal services. At the same time, earthquakes can directly damage health facilities, paralyse medical supply chains and transportation, hence disrupting the delivery of medical services, making it difficult for people to access care. We need to evaluate the situation regularly to tackle barriers and carry out various types of humanitarian relief work.

One of the most common medical issues we face after earthquakes is “crush syndrome”, a condition where muscle tissues damaged by severe internal injury release toxins into the bloodstream and lead to kidney failure. If left untreated, the condition can be fatal. As early as 2008, MSF donated equipment like a dialysis machine to Sichuan, China after the earthquake for treating crush syndrome, and three nephrologists or kidney specialists were sent there to help. For the 2009 Indonesian earthquake in Padang, MSF sent emergency teams with medical materials from Brussels, Paris and Panama. Three nephrologists from the ‘Renal Disaster Relief Task Force’ from the University of Ghent, Belgium also went with the MSF team to focus on handling crush syndrome patients.

Beside physical injuries, a natural disaster can cause indelible mental traumas to the survivors. These psychological effects could lead to physical health problems, such as muscle pain and eating disorders. MSF provides psychosocial support at the scene to help survivors deal with the traumas they experienced and get them back on track.

Usually in a natural disaster, our feelings and emotions might be much more aroused than facing other long-term events. MSF counsellors try to let the patients identify and rearrange their feelings, rebuild their inner-selves and avoid these effects turning into long-term sickness.

After the earthquake in Türkiye and Syria in February this year, MSF was supporting local organisations in providing psychosocial support to people in affected areas. As of 31 May, 10,133 people received psychosocial support. Some people were having nightmares every day, becaming forgetful and lacking appetite. “In one of the villages, the participants said their houses ‘had now turned into monsters’. People used to take refuge in their homes, but now homes have turned into a place of fear, a place that kills them,” says Adiyaman Nazlı Sinem Koytak, a psychologist for İmece İnisiyatifi, a local organisation.

Aside from direct psychological counseling, MSF also provides training to people like medical staff and community leaders to teach them about severe mental health problems and counseling techniques. This way they can help patients and colleagues and learn to help themselves. In 2016, MSF psychologist was in Manabi province, Ecuador, to provide training to health workers, psychologists, university teachers, social workers and community leaders as well as supporting earthquake victims. The team provided psychological care and training to more than 1,280 people.

Mental health problems can be long lasting, and MSF provides continuing support, depending on the situation. In 2014, many children were among the victims of typhoon Haiyan, with one school in the Tacloban area of the Philippines losing 59 of its pupils. MSF provided a mental health programme that targeted schoolchildren, mothers and other people struggling with serious psychological issues three months after the disaster and provided them with specialised care. In 2022, when Typhoon Rai hit the Philippines, we commenced mental health support activities, and scaled up our response when we found that the demand was still enormous in an assessment carried out two months after the catastrophe.

Natural disasters bring huge challenges to people, MSF strives to get to the most affected areas as soon as possible to provide medical aid to those with the greatest needs. Although you cannot be at the front line to provide medical aid to the needy, your contribution can always help vulnerable people access medical assistance. We invite you to join 7.7 MSF Day to listen to the victims’ needs and donate a day of your income to respond to these voices.