Death and Disease Stalk Quake Survivors

by Zofeen T. Ebrahim

(IPS) KARACHI -- With thousands of bodies buried and rotting under the rubble of what was once their homes, the survivors of Pakistan's worst earthquake now risk disease as they search vainly for signs of life and go about burying the dead they can retrieve.

"I cannot even begin to describe to you the extent of the human tragedy. There are decomposed bodies lying about although you witness mass burial taking place every day," Shershah Syed, who is leading a team of doctors in badly-hit Mansehra district in the North West Frontier Province (NWFP), told IPS by telephone.

"Every second person you meet is crying. The scale of psychological trauma has not even been measured, so busy are they trying to heal the physical wounds," Syed said.

But what worries doctors and relief workers who have just begun reaching quake-affected areas from Pakistani cities are collapsed sanitation and drinking water supply systems days after the NWFP and adjacent Pakistan administered Kashmir were devastated by the Oct. 8 earthquake that measured 7.6 on the Richter scale.

While the death toll is officially placed at around 35,000, the earthquake may easily have wiped out twice that number and the United Nations estimates that some four million people are affected and two million rendered homeless after entire towns and villages were wiped out.

"If we don't act fast there are chances of widespread diarrhea, cholera, typhoid and measles. Even polio, a disease that had almost been eradicated may resurface," said Qaisar Sajjad, general secretary of the Pakistan Medical Association in Karachi.

Sajjad said deteriorating sanitary conditions further endangered people already weakened by trauma, poor nutrition while the pouring rain could hasten the decomposition (and in turn contamination) of dead bodies and animal carcasses.

More deaths and disease can only be expected as the survivors will be forced to live huddled close together and depend on water contaminated by the putrefaction all around them, doctors said.

Khalif Bile, head of the World Health Organization (WHO) in Pakistan told reporters that if water safety was not addressed and shelter needs not attended to there would "huge health problems."

"People who've been displaced and are sharing tents are at great risk of catching infectious diseases which can trigger an epidemic. Again, insufficient access to clean drinking water, medical aid, food and insanitary living conditions can trigger widespread illnesses," said Sajjad.

The English language daily 'Nation' quoted Isabelle Simpson, the chief of Paris-based Medical charity, Medecins Sans Frontieres (MSF) as saying: "We are worried that the damage due to quake could lead to outbreak of other water-borne diseases. Especially as very few people have shelter up there, they're crowding into homes and camp-type situations, so there's a lot of potential for health risks."

But those who are forced to live in the mountain regions without shelter are equally vulnerable, according to other physicians working in Mansehra and contacted by IPS over telephone.

"Respiratory infections may become rampant," said Ashraf Nizami who is heading another medical team that has arrived in Mansehra from the city of Lahore, which is treating about 1,500 patients every day said the basic health structure in the area has completely collapsed.

His biggest fear is a rise in cases of pneumonia, if measures are not taken to provide shelter for the victims in this high altitude region, especially with winter setting in.

The WHO is gathering essentials for a mass immunization program against measles as vaccination coverage is low in this region. At least 90 percent of the population must be immunized to prevent an epidemic of measles, which can be fatal to children.

There is a need to bring to life the collapsed health system said Jan Vandemoortele, UN Resident Coordinator for Pakistan. While the world is calling attention towards a looming wave of infectious diseases, the doctors are working on a day-to-day basis in the field, fighting against time, to save those injured by the quake.

Teams of doctors moving in ambulances are trying to reach the remotest villages in the Himalayan region and providing medical relief. "Our teams of young doctors comprising general surgeons, anesthesiologists and paramedics has begun visiting villages on foot," said Nizami, who said he himself performed 25 operations on Thursday including eight major operations.

"Most of the people here are suffering from hip and long bone fractures, head injuries and rib fractures," said Nizami who said he has already seen several cases of gangrene where amputations were required.

"If aid doesn't get to them on time, there will be many more such casesˆ while delayed fractures can be manipulated, wounds that are not treated immediately catch infection which reaches to the bone, resulting in amputations," Sajjad explained.

Many of the survivors are also reporting blunt injuries caused by pressure to muscles, bones or nerves, say, from heavy beams or falling masonry. "The victim may look healthy with no outward injuries but blunt injuries can turn fatal especially when accompanied by blood loss, poor water intake and psychological trauma," Sajjad said.

The UN has issued an appeal for 3.2 million dollars anticipating the needs of women especially tens of thousands of pregnant women and the newborn. According to Syed, the physical and psychological trauma caused by the earthquake could push up maternal and infant deaths. "We need to look at providing emergency obstetric services to avoid this."

Much of the activity in Mansehra is centerd around a makeshift 400-bed hospital that has been set up in one of the structures still standing and sound -- a college building.

Syed described it as "a place where the patients brought from the villages can just get basic aid. There is complete mayhem. There are enough doctors but there is no management," he said.

In contrast, the foreign medical teams that have arrived in the area seem to have "come with a plan," said Syed.

"While no one can surpass our intense emotions they (foreigners) are working quietly and systematically. The Italian team has taken over the sanitation system in one area while the Turkish team another. There is no duplication in their work. The Italian doctors and the Japanese, too, have set up tent hospitals and are doing work in an organized manner," Syed said.