Abstract
After a massive disaster, many residents in affected areas are forced to temporarily stay in evacuation shelters. The exact impact of the state of resource supply and infrastructure in evacuation shelters on the health status of evacuees has not been sufficiently studied. Two weeks after the 2011 Great East Japan Earthquake (GEJE), comprehensive surveillance related to the health status and hygiene level was performed for all evacuation shelters (328 shelters with 46,480 evacuees at the peak) in one of the most devastating medical zones after the tsunami hit the area (Ishinomaki City). The joint relief team regularly visited all evacuation shelters across the area to assess the situation of resource supply levels, infrastructural damage, rapid need of resources, and the health status of the evacuees. In this cross-sectional observational study, we evaluated the relationship between the resource supply levels and health status among evacuees in two time periods (days 14–19 and 20–25). Among the evaluated vital resources, clean tap water supply was among the most disrupted by the disaster, and was not fully restored in most shelters during the assessment period. The cross-sectional relationship between resource supplies and morbidity was inconsistent between the two assessment periods, reflecting the multifactorial nature of health status in evacuation shelters. The clean tap water supply level at the first assessment showed a strong negative correlation with the subsequent prevalence of respiratory or gastrointestinal infectious conditions at the second assessment. Restorations in the clean tap water supply and toilet hygiene correlated each other, and both correlated with a decrease in the prevalence of gastrointestinal infectious conditions. In conclusion, disrupted clean tap water supply and inadequate toilet hygiene after a massive disaster would jointly harm the health status of those in shelters. Prompt assessments using quick visual assessment and restorations of these key resources have validity with suppressed environmental health risks among evacuees.
Highlights
After a massive catastrophic disaster, humanitarian actions are needed to protect life and health of disaster victims, with dignity, comfort and security [1]
Shelter surveillance to assess the level of hygiene, conduct rapid need assessment, and assess the health status of evacuees after massive disasters has been performed worldwide [5, 6, 7], like when the 2005 Hurricane Katrina struck Louisiana
Based on accumulated experience and knowledge, several guidelines have been developed in the humanitarian sector, such as the Sphere Project, Active Learning Network for Accountability and Performance in Humanitarian Action (ALNAP), and Humanitarian Accountability Partnership (HAP), to standardize humanitarian aid activities in response to natural and manmade disasters [1, 18, 19]
Summary
After a massive catastrophic disaster, humanitarian actions are needed to protect life and health of disaster victims, with dignity, comfort and security [1]. After a catastrophic natural disaster like and earthquake with tsunamis, many survivors from all socioeconomic categories are forced to evacuate to non-home-like conditions, like evacuation shelters [2]. Such survivors are known to suffer from many mental and physical disturbances during their mid-to-long term displacement [3, 4]. Possible relationships between disaster-derived stress and cardiovascular, renal, or metabolic diseases have been reported [15, 16, 17] To suppress such environmental health risks among evacuees, resource supplies and sanitation are known to be critical determinants as an inextricable human right [1]. The short-to medium-term impact of resource supply levels and infrastructural damage of post-disaster evacuation shelters on the physical health of the evacuees—such as the prevalence of common physical symptoms—has yet to be thoroughly studied
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