Health impacts of the widespread floods

The floodwaters are starting to recede in parts of El Salvador and the rain has stopped.   Public health concerns throughout the flooded areas are of immediate importance.   People have been crowded into shelters, flood waters have contaminated wells, and contact with the dirty water can cause disease.  Only diligent attention to providing clean water and sanitation will prevent outbreaks of illness.

Attention is being paid by a number of organizations.  Here is today's report of the Pan American Health Organization:

El Salvador.  The rains have opened dam reserves and blocked roads affecting 181 out of 262 municipalities of El Salvador. 2,000 square kilometers are now flooded which is equivalent to 10% of the entire national territory. 

Health Impacts.  Currently there 250,000 people affected and 38,682 persons displaced to 603 shelters located mostly in the departments of La Libertad, Usulutan, and La Paz. It is estimated that 12% of the displaced people in shelters will need temporary housing for 4 to 6 months. 

The Ministry of Health has reported increased cases of diarrhea, conjunctivitis, chickenpox, and dengue fever. A total of 159 health centers are affected including 17 with severe damages, 36 with moderate damages and 106 with minor damages. Hospital Soyapango which serves 290,000 has lost its power source. Hospital Sonsonate reported that there are limited surgical and maternity capacities as well as blocked roads to the hospital. Most health centers are experiencing floods and equipment damages.

The El Salvador Ministry of Health reports that it has been active providing care in the shelters and that the primary conditions found have been respiratory diseases and rashes. The Ministry has been providing health checks, mental health therapies and sanitation evaluations.  Bulletins of the Ministry of Health relating to the flooding appear here.

Our friends at Voices on the Border did a good overview on all these health issues in a post yesterday which I re-post here:

As floodwaters continue to recede, communities throughout El Salvador are starting to consider the short and long-term impact of the 1400 milimeters (55 inches) of rain that has fallen in the past week. One of the most immediate issues is public health. 

According to Eduardo Espinoza, Viceminister of Health, the most immediate public health concern in El Salvador is the 2,200 community wells contaminated by flooding, which threaten the availability of safe drinking water. The Health Ministry announced yesterday that it is distributing ‘Puriagua,’ a chlorine solution used to disinfect contaminated drinking water. Other organizations are also distributing chlorine-tablets and purified water. Although the wells pose a significant health concern, “the risk of outbreaks can be minimized” through prompt action to identify wells and provide clean drinking water, according to the World Health Organization (WHO). 

Flooding can increase the risk of communicable diseases in a number of ways – contaminated water can cause gastrointestinal diseases; floodwater can bring disease-carrying animals such as dogs, rats or mosquitoes into closer contact with humans; direct contact with waste carried by floodwater can cause skin disease; and exposure to weather conditions can lead to respiratory ailments. 

The most prevalent health concerns, so far, seem to be respiratory and skin problems, judging by the number of consultations at shelters nationwide. Out of 9,139 health consultations made by October 17th, 2,395 dealt with respiratory problems, primarily among the very young and the elderly. The Health Minister recommended that special care be taken to wrap these vulnerable groups warmly. Another 1,231 consultations dealt with skin problems. However, according to the World Health Organization, neither problem is “epidemic-prone.” 145 consultations dealt with gastrointestinal diseases and diarrhea. 

Other “epidemic-prone” diseases are being monitored closely. The Panamerican Health Organization (PAHO) has donated diagnostic kits to monitor the spread of H1N1, dengue, malaria, and a disease called leptospirosis carried by rodents and dogs. Espinoza reported five cases of chicken pox in the Municipality of Cojutepeque, which have been addressed with “isolation measures and antiviral treatment to contain the spread of the disease.” Espinoza also reported six cases of the H1N1 virus under isolation. “So far, there has been no case [of H1N1] in the shelters,” says Espinoza. 

Another public health problem is that flooding has damaged 138 health establishments, according to the Health Ministry. As just one example, the PAHO reports that the infrastructure at the Kidney Health Unit in the Lower Lempa has been “completely damaged” by more than two meters of water, “losing the medical equipment vital to treat renal failure.” The organization writes, “This unit treats 350 patients with chronic renal failure, who, currently, have no other alternative.” 

Dr. Anne Daul, a fellow with the the George Washington University department of Emergency Medicine, added that flood victims also need to be concerned about the psychological impact from loosing a home or even loved ones. She also warns that major catastrophes such as this can break down the social fabric, which puts women at risk of gender-based violence.