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Health Situation Reports


Water - Purification

In order to drink the water, you should be prepared to treat it. There are numerous methods of water purification, described below. Please note the use of iodine, which is cheap and freely available. Recommended as a source of emergency water purification.

  • Boiling - Boiling is the most certain way of killing all microorganisms. According to the Wilderness Medical Society, water temperatures above 160° F (70° C) kill all pathogens within 30 minutes and above 185° F (85° C) within a few minutes. So in the time it takes for the water to reach the boiling point (212° F or 100° C) from 160° F (70° C), all pathogens will be killed. No need to keep the water boiling!
  • Cheapest and Easiest Drinking Water - Solar Method (SODIS) and WHO approved - Learn and Teach SODIS POTABLE WATER (
  • Water - Purification - Solar Cooking
    • For water safety, maybe use solar cooking (, as boiling needs a source of energy which not always will be available. Solar cooks can be built cheaply with available resources, and if done apropriately can be used to warm up water for long enough to kill most germs. Perhaps a bit tricky, but better than nothing, and maybe better than setting up fires. It depends on the location.
    • ORIGINAL SOURCE (Water Purification) and further clarification, contact: Dr Charles Johnson, Emergency Physician,
  • General Chemical Treatment Procedures
    • The effectiveness of all chemical treatment of water is related to the temperature, pH level, and clarity of the water. Cloudy water often requires higher concentrations of chemical to disinfect
    • If the water is cloudy or filled with large particles, strain it, using a cloth, before treatment. Large particles, if swallowed, may be purified only "on the outside"
    • Add the chemical to the water and swish it around to aid in dissolving
    • The water should sit for at least 30 minutes after adding the chemical to allow purification to occur. If using tablets, let the water sit for 30 minutes after the tablet has dissolved
    • Chemically treated water can be made to taste better by pouring it back and forth between containers, after it has been adequately treated. Other methods include adding a pinch of salt per quart or adding flavorings (e.g., syrup mix, etc.) after the chemical treatment period
    • Additional Water Help Including Bleach Method - Emergency Disinfection of Drinking Water (
  • Iodine Treatment
    • Iodine is light sensitive and must always be stored in a dark bottle. Iodine has been shown to be more effect than chlorine-based treatments in inactivating cysts. Let water stand for at least 30 minutes before use. Generally, the procedure is as follows:
      • Iodine Preparations
      • Preparation Iodine => Amount/Liter
      • Iodine Topical Solution 2% = 8 drops per liter
      • Iodine Tincture 2% = 8 drops per liter
      • Lugol's Solution 5% = 4 drops per liter
      • Povidone-Iodine (Betadine®) 10% = 4 drops per liter
  • Chlorine Treatment
    • Free chlorine is the most widely and easily used, and the most affordable of the drinking water disinfectants. It is also highly effective against nearly all waterborne pathogens (except Cryptosporidium parvum oocysts and Mycobacteria species). At doses of a few mg/litre and contact times of about 30 minutes, free chlorine generally inactivates >99.99% of enteric bacteria and viruses.
    • For point-of-use or household water treatment, the most practical forms of free chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and bleaching powder (chloride of lime; a mixture of calcium hydroxide, calcium chloride and calcium hypochlorite).
    • The amount of chlorine needed depends mainly on the concentration of organic matter in the water and has to be determined for each situation. After 30 minutes, the residual concentration of active chlorine in the water should be between 0.2-0.5 mg/l, which can be determined using a special test kit.

Water - Sanitation Management in Disasters Resources

Most are PDF files with illustrations which can be downloaded and print outs given to teams for training and to teams heading for relief work in affected areas

May be helpful but written for East Coast USA

Disease - Prevention

From Center for Disease Control - USA

  • Clean hands save lives. How to do it:


  • Universal Precautions

Protect yourself while helping others (scroll down for information) Universal Precautions (

Dead Bodies - Information on Handling

  • Sources of Information
    • Fear of Dead Bodies unfounded PanAmerican Health Organization (
    • WHO (
  • Possible risks with handling dead bodies
    • Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid
    • Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections
  • Precautions to be used by all persons working with bodies
    • Vinyl or Latex gloves should be worn
    • Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes
    • Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
    • Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed.
    • Graveyards should be at least 30m from groundwater sources used for drinking water
    • The bottom of any grave must be at least 1.5m above the water table with a 0.7m unsaturated zone. **Surface water from graveyards must not enter inhabited areas.
    • Ensure universal precautions for blood and body fluids
    • Ensure use of body bags
    • Ensure disinfection of vehicles and equipment
    • Bodies do not need to be disinfected before disposal (except in case of cholera)
    • Vaccinate workers against hepatitis B


Disease Surveillance

  • In disease surveillance following are important
    • a network (perhaps a hierarchy with some extra confirmation points) of trusted sources
    • case definitions (are we counting deaths, diseased, people at risk? do we count those with diarrea? do we need to define "fever"?)
    • needed data (do we need the age of the people with that disease? or just the numbers? what do we need to know?)
    • ways to communicate the data to the people who count up the numbers
    • ways to spread the information to people who can do practical things
  • In case of Malaria
    • It is important to track weekly case numbers and provide laboratory-based diagnosis (perhaps only for a % of fever cases to track the slide/test positivity rate), to pick up the early stages of a malaria epidemic
    • Active search for fever cases may be necessary to reduce mortality in remote areas with reduced access to health care services
  • Causes
    • Cholera is an intestinal infection caused by a bacteria - and is often linked to contaminated supplies of drinking water
    • The bacterium is part of the flora of brackish water and estuaries - it is when this water gets into the drinking supply that an outbreak can start
  • Symptoms
    • It causes severe diarrhoea and vomiting, and patients, particularly children and the elderly, are vulnerable to dangerous dehydration as a result
    • Most symptomatic cases are hard to distinguish from other illnesses that cause diarrhoea - it is only in one in 10 that severe symptoms such as dehydration occur.
  • Corrective Measures
    • Clean water and rehydration salts are required, but they are often in short supply in areas where they are needed most
    • Normally, rehydration salts are the only treatment given, although severely dehydrated patients may need intravenous fluids
    • Antibiotics can reduce the amount of diarrhoea
    • Systems for hygienic disposal of human wastes also need to be brought in
    • Cooking practices need to be made as safe as possible - where practicable, food needs to be cooked thoroughly and eaten while hot, and raw fruit and vegetables avoided unless they are peeled first
    • Handwashing after going to the toilet is a vital measure to prevent the spread of the disease
Dengue Fever
  • Causes
    • Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. People get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite.
  • Symptoms
    • Symptoms of typical uncomplicated dengue usually start with fever within 5 to 6 days after a person has been bitten by an infected mosquito. Symptoms include: high fever, up to 105 degrees Fahrenheit, severe headache. retro-orbital (behind the eye) pain, severe joint and muscle pain, nausea and vomiting, and rash. The rash may appear over most of the body 3 to 4 days after the fever begins. A second rash may appear later in the disease. Most children infected with dengue virus never develop typical symptom
  • Treatment
    • There is no specific treatment for dengue fever, and most people recover completely within 2 weeks. To help with recovery, health care experts recommend getting plenty of bed rest, drinking lots of fluids, taking medicine to reduce fever. People with dengue fever should NOT take aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are safe for most people.
  • Prevention
    • The best way to prevent dengue fever is to take special precautions to avoid contact with mosquitoes.
  • Link to Dengue Fever Indormation from CDC CDC (
  • David W. Moskowitz, MD, FACP, is willing to volunteer a patent-pending approach he believes will work for Dengue Fever, which has been successful against West Nile virus encephalitis and uses readily available pharmaceuticals. Healthcare providers can email him at
Hepatitis E
  • Causes
    • Malaria is caused by infection of a parasite which is carried from person to person via mosquitoes
    • Increase in the cases of Malaria recently because of development of resistance to traditional drugs, mosquitoes becoming resistant to insecticides and changes in the environmental conditions
  • Symptoms
    • The first is high fever, followed a few hours later by chills. Two to four days later, this cycle is repeated
    • The most serious forms of the disease can affect the kidneys and brain and can cause anaemia, coma and death
  • Corrective measures
    • The spread of the disease can be reduced by cutting down the mosquito population, for example by filling ditches where mosquitos breed
    • Early diagnosis can lead to successful treatment so education in spotting the symptoms of malaria is important
    • Bed nets coated in insecticide have also reduced the incidence of the disease by up to 35%, according to the World Health Organisation
    • Artemisinin-based combination therapy should be provided when a falciparum malaria epidemic is confirmed
  • Three casesof ( fungal infection reported in returnees to AUS
    • 27 Jan 2022 ( Dr. Pamela Konecny (St George Hospital, Sydney, Australia) and colleagues describe the first tsunami-related case of mucormycosis, identified in a 56-year-old man who was transferred from Sri Lanka to a Sydney hospital for treatment after being injured when the tsunami hit on December 26, 2004.
      • The mainstay treatment for mucormycosis is early surgical intervention to remove all dead and infected tissue, along with intravenous and antifungal therapy. Mucormycosis has a high mortality rate even with aggressive surgical intervention. Death rates range from 20-80% depending on the site involved and whether the patient has any underlying immune problems.
      • Dr Pamela Konecny, Department of Immunology & Infectious Diseases, Staff Specialist Infectious Diseases, St George Hospital, 2 South Street, Kogarah NSW 2217, Australia. T) +61 2 93502955
  • Post-tsunami tetanus story (
    • 18 Jan 2022 reported by VOA: 65 cases in Indonesia. 4 of 20 patients have died at main hospital in Banda Aceh. Treatment provided by a team of medical volunteers from Singapore, who have flown in to assist Aceh's victims. Dr. Anton Cheng is part of the team. He would like to temporarily paralyze the patients to rid them of their spasms, but that would involve putting them on ventilators in intensive care, but there is no intensive care ward, and few ventilators. There is lowimmunization coverage.
    • The World Health Organization says it has enough immunization doses, and sufficient medical staff to administer them. Doctors can theoretically protect those now being exposed to the bacteria - for instance, those who receive cuts while digging through the rubble for bodies or possessions. But immunization might be too late for many who were exposed three-weeks ago and are still incubating the infection.
Post-traumatic stress prevention
  • Region Specific Guidance for aid workers in dealing with psychological health of tsunami affected persons, especially children:
  • Links and information related to psychological support for trauma after any disaster
  • Medline Plus (
  • National Center for PTSD (
  • Self Care and Self Help (
  • Survivior Fact Sheet (
    • Most disaster survivors only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one out of every three disaster survivors experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:
      • Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember); Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks); Extreme attempts to avoid disturbing memories (such as through substance use; Extreme emotional numbing (completely unable to feel emotion, as if empty); Hyper-arousal (panic attacks, rage, extreme irritability, intense agitation); Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions); Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)
      • Most child and adult survivors experience one or more of these normal stress reactions for several days: Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities); Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame; Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive; Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling
  • Helping Children and Adolescents Cope with Violence and Disasters, NIH Publication No. 01-3518, dated 2001 (
    • Youngsters who have experienced a catastrophic event often need support from parents and teachers to avoid long-term emotional harm. Most will recover in a short time, but the few who develop PTSD or other persistent problems need treatment.
    • For children 5 years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.
  • Center for Treatment of Psychotrauma (
    • The symptoms that characterize Post-Traumatic Stress Disorder (PTSD) can be divided into three main categories: Re-experiencing; Avoidance; Hyper-arousal
    • Natural Recovery Process ( What can be done immediately after the traumatic event? Return to routine: Try to get back to normal, as much as this is possible. Take care to get enough sleep: At this stage the body expends an enormous amount of energy and sleep is the way to restore this energy. Stay in touch: Keep in touch with those near to you, family and friends, and share your feelings with them. Limit media exposure: Try to control the amount of news and disturbing pictures you are exposed to via television, radio and newspapers. Postpone judgment to a later time: At this stage many people blame themselves for their behavior during the event. In many cases this is unjustified, but they have trouble seeing that on account of the emotional turmoil they are currently experiencing.
    • Theraputic Resources ( world-wide listing from Australia.
    • photos ( of drama group and sea re-acclimitisation on Sri Lanka
Acute Kidney Failure
  • A frequent problem in land-based earthquakes is kidney failure from crush injuries and/or dehydration. The recent tsunami, by disrupting drinking water supplies, will also cause acute kidney failure due to dehydration.
    • Acute kidney failure normally requires kidney dialysis. Machines for blood-based dialysis ("hemodialysis"), or supplies for peritoneal dialysis can be quite scarce in areas devastated by the tsunami.
    • A new treatment which has been successful in pilot clinical trials in both adults and infants involves the use of an already existing medicine infused intravenously into the survivor's arm. For details:
      • Could this be aminophylline ?
        • Link to Article ( 2000 article: "the renoprotective effect of intravenous aminophylline was evaluated on the perfusion on kidneys undergoing SWL [shockwave lithotripsy]." "Five of these patients were treated with 500 mg of intravenous aminophylline 45 minutes prior to SWL."
        • Link to 1983 Article ( Can the renal vascular response to amphotericin B be blocked by aminophylline? "Toward this end, the effect of aminophylline on the renal response to amphotericin B in sodium-depleted dogs was examined."
        • Link to Google Search on topic ( about 272 articles from for aminophylline kidney

Medical precautions before travelling to affected areas

  • CDC Guidance to Travelers Going to Region ( also mentions rabies, electrocution from portable generators.
  • Advice for Health Care Professionals ( Travelers ideally should be assessed by a health-care professional at least 4-6 weeks before travel so recommended vaccines that require spacing over several weeks can be completed.

Medical follow-up on return to one's native country


Earthquake - Safety Tips

SAFETY TIPS BY THE MALAYSIA CIVIL DEFENCE FORCE >> The Malaysia Civil Defence Force has issued some advice on what you should do when a tremor occurs.

  • If you are indoors, do not rush for the exit as it may start a stampede; instead, take cover under the table or against interior walls.
  • Stay away from windows, shelves or fixtures that could fall and hurt you.
  • Do not use candles, matches or other naked flames as there may be gas leaks.
  • If your are outdoors, stay away from buildings and overhead electrical cables; remain in the open until the tremor stops.
  • If you are driving, stop quickly and stay in the vehicle. However avoid stopping near or under buildings, trees, bridges, overpasses or electrical cables.
  • After the tremor has stopped, do not touch damaged electrical wiring. Report any gas leaks.
  • Call the police, if anyone has been injured, then check your home for structural defects and alert the relevant authorities.

Disaster Reduction

Standards: Humanitarian Assistance

Sphere Handbook ( Sphere Humanitarian Charter and Minimum Standards in Disaster Response sets out what people affected by disasters have a right to expect from humanitarian assistance. Launched by Red Cross and Red Crescent, it lays down minimum standards to be attained in disaster assistance in water supply and sanitation, nutrition, food aid, shelter and health services.


  • USA CDC for clinicians (
  • England Lancet (

NonEnglish references

Concerns Regarding Relief Materials

This is a report from the field which comes from an unknown source, likely in Sri Lanka. It is particularly useful in understanding local viewpoint and requirements regarding material provided for tsunami relief efforts.

Government organizations in affected countries should controlling this aspect of the massive influx of aid materials

Major threats some aid material could pose:

-Clothing, toys and household items sent sometimes seems to be secondhand clothes and one has to be careful as any person with various easily transmittable decease as a skin deceases could have given them away. Usually, all European companies engaged in the SecondHand clothing trade are required to have a certificate of disinfect ion for each consignment. This usually gives details of how exactly the items had been disinfected. In Sri Lanka and Indonesia where the garments industry is thriving there shouldn’t be a problem for clothing the affected people as even aid money could be used to purchase them cleaner clothes. It would be a great shame and insult if children and adults in these countries are allowed to live in soiled used clothes and suffer from unknown long-term illnesses.

-Medicines and doctors –in some countries such as former soviet countries they have very poor quality drugs and medical care, which even their own citizen refuse to use. Also counterfeit drugs, products had been improperly stored, contaminate by infections and radiation and containing dangerous elements are wide spread.

-Medical equipment and supplies – could be defective, partly used, or some products could also be contaminated by various infections, radiation and contain dangerous elements.

-Food items, there are possibilities some products had been improperly stored, contaminate by radiation and contains dangerous elements.

-Building materials – could also be contaminated by radiation and can contain dangerous elements, asbestos dust and mercury etc.

It must be made compulsory to get a preliminary approval from a quality controlling organization in Sri Lanka (after a simple detailed checking of packing lists etc) before any consignment is shipped or air lifted to SL–they should ask for more specifications and clarifications if needed.

After arrival of shipments, each consignment should be inspect for radiation contamination –(Radiation level measuring equipment are small, and very easy to use, so it shouldn’t hamper the movement of aid materials to needed areas)

They should take samples from each consignment for later thorough tasting in a laboratory. [