Direct Relief Staff Member Matt MacCalla reports back from Bangladesh with a situational report on the health situation there following Cyclone Sidr. Direct Relief has committed $1.5 million in resources to the Sidr response. Direct Relief is continuing to build its in-country network of healthcare providers in Bangladesh to assist with this response and further develop long-term partnerships.

Cyclone Sidr, deemed a “super cyclone” by the World Health Organization (WHO), struck on the evening of November 15, 2007, and although only lasting for a few hours, it inflicted heavy damage. Winds reached over 300 kilometers per hour, and a wall of water more than 20 feet high swept across the Bangladesh coast. Official government estimates state that Sidr killed approximately 3,000 people, but estimates from nongovernmental organizations project a death toll nearly twice that figure.

The few roads, already in poor condition, were made worse by the cyclone, hampering transportation of emergency response assistance. Electricity already prone to power outages was out for almost two weeks. Thousands of families lost relatives, their homes, and their livelihoods, as fishing boats and agricultural fields were destroyed.

Although this area is hit by a number of cyclones each year, and there was warning that Cyclone Sidr was going to be especially consequential, there was still only one cyclone shelter for tens of thousands of people in the affected area, and most national and international relief efforts and teams did not arrive on the scene for more than a week or two later. The government responded quickly, sending teams of medical personnel to the area for health and trauma care, and by deploying the military to begin rebuilding and to provide logistical support.

While most relief efforts have ceased, a wide variety of needs remain. Most homes in the area were not officially registered (nor were the people living there), so victims often cannot claim government aid. Large numbers of people were killed in a small geographic area, and the social and psychological damage has been severe and largely unaddressed.

Comprehensive, thorough health care is needed more now than perhaps ever before.  People are at higher risk of illness because their damaged homes cannot keep out the cold and wet weather. With the monsoon season coming in a few short months, the situation will only become more critical.  And, with a compromised water supply and damaged or destroyed crops and fishing boats, people have deficient access to safe and reliable food and water.

While visiting the WHO’s office in Bangladesh, I was able to learn more about these and other health care concerns. According to Dr. Moazzem Hossain, the Director of Emergency Preparedness and Response (EPR) at the Ministry of Health, there were 690 medical teams dispatched to the cyclone-affected area. Each team was made up of a doctor, medial assistant, and paramedic. In total, there were 1,204 doctors and specialists on duty. However, the number of patients overwhelmed their relatively few human resources. The official death toll was 2,929, with 12,979 injured. In the first month after the cyclone, the number of patients was overwhelming: 3,849 with diarrhea, 4,858 with pneumonia, 8,581 with skin diseases, 2,848 with eye infections, and 12,353 with fever/typhoid.

The government has called for an intensification of disease surveillance for acute respiratory infections, water and food-related diseases, and vector-borne diseases. In addition, it has called for more and better water quality assurance, sanitation, and human waste disposal, an increased effort in health promotion and education, more assistance for reproductive and psychosocial needs, the replenishment of buffer stock in medical supplies and equipment, and the reconstruction of damaged health facilities.

The government realizes there is still a large amount of work to be done in order to be better prepared for another cyclone of this magnitude.  It has set in motion the establishment of an institute of disaster management and the provision of water purifying machines and mosquito nets. The government recognizes the need for Hepatitis, Rotavirus, Typhoid and Cholera vaccines, local field ambulances, a river ambulance, a helicopter medi-vac, and a mobile sanitary latrine. It has committed to the construction of additional cyclone shelters, and special high-rise schools, houses, and hospitals. Finally, it has come to the heart breaking conclusion that better mass casualty management is needed, as well as better coordination at all levels with governmental, non-governmental, and donor organizations committed to disaster management and recovery.