Now the second wave
That includes cholera, typhoid fever, dysentery, and other diseases
Water can kill in more than one way.
Even as rescue workers labored to recover the bodies of tens of thousands of people killed by last week's tsunami, public-health officials and international aid organizations were racing to confront the threat of water-borne disease, which could prove to be as deadly as the floodwaters themselves. "Perhaps as many as 5 million people are not able to access what they need for living," said David Nabarro, head of the World Health Organization's crisis team. "Either they cannot get water, or their sanitation is inadequate, or they cannot get food."
Last week, workers from dozens of international relief organizations flew into the stricken regions, charged with helping people there get the barest elements of survival. "We're ramping up our efforts to deliver the basics--food, water, shelter, medicines," says Mike Kiernan, spokesman for Save the Children. "Our immediate concern is combating disease." The response has differed greatly around the region. In India, UNICEF was able to start moving water tanks to afflicted communities within 24 hours of the flood and flew water purification tablets and oral rehydration salts to Sri Lanka on Wednesday. In the Ache region of Indonesia, the relief organization on Thursday was still assessing what needed to be done.
Burials first. Some initial efforts, while well intended, haven't necessarily been effective. Rescue workers across Asia spent the first week after the tsunami rushing to bury corpses. But health officials say that contrary to popular belief, dead bodies aren't a major source of disease. Instead, the greatest threat they pose is to the mental health of the survivors. Despite the urge to remove such distressing sights quickly, the World Health Organization last week asked relief workers not to dump bodies in mass graves but rather give families "the opportunity to conduct culturally appropriate funerals and burials according to social custom."
Of all the things that survivors need to stay alive in the weeks to come, clean water is most critical and can be the most difficult to come by. Flooded wells are contaminated with salt water or with bacteria from human and animal waste; rainwater catchment systems are destroyed, and water treatment and sewer plants flooded. Public-health officials' biggest fear is that the lack of clean water will prompt outbreaks of deadly shigellosis, cholera, or typhoid fever and increase the incidence of diarrhea, which kills 2.2 million people annually worldwide, mostly children. "Water sanitation is going to be an enormous problem, especially in makeshift encampments," says Ronald Waldman, a physician and director of the Program on Forced Migration and Health at Columbia University. "That's a breeding ground for all kinds of disease."
By last Thursday, doctors in afflicted areas were starting to report increased cases of respiratory ailments and diarrhea. "The biggest requirement today is water, since all the water sources have been contaminated," said J. V. Raaman, an emergency physician working in Nagapattinam, on the Indian Coast. "There is a grave risk of this blowing up to epidemic proportions if steps are not taken immediately."
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