Forty-ninth Regional Committee for Europe: Florence, 13 - 17 September 1999: the earthquake in Turkey: its health implications

W O RLD HEALTH O R G A N IZA TIO N Regional O ffice for E urope C openhagen REGIONAL COMMITTEE FOR EUROPE Forty-ninth session, Florence, 1 3 - 1 7 September 1999 Provisional agenda item 3(g) EUR/RC49/Inf.Doc./6 14 September 1999 13249 UNEDITED - ENGLISH ONLY T h e E a r t h q u a k e in T u r k e y : its H e a l t h Im plic a t io n s On 17 August 1999 at 03:02 a.m. (local time) Turkey suffered the effects o f a devastating earthquake with the magnitude o f 7.4 - 7.8 on the Richter scale. The earthquake affected quite a large area inhabited by approximately 20 million people covering Istanbul, Kocaeli, Sakarya, Bolu, Yalova, and Bursa provinces. As o f 8 September, the death toll o f the earthquake was 15 303. A total 23 983 injuries have been reported. More than 300 000 people are homeless. Search and rescue efforts were initiated as soon as possible. Almost all the hospitals in the region were at least partially operational and started to provide services in tents. Transportation o f casualties was ensured through ambulance services and airborne evacuation to local health facilities, as well as to facilities in other cities. The control o f transmission o f epidemic-prone diseases and sanitation services have been issues o f high concern. From the third day onwards, psychosocial services were initiated and solidarity units have been established. The Turkish Government has been supported by many other governments and nongovernmental organizations that have provided search and rescue teams, medical personnel and supplies, . including tents and drugs, as well as firefighting support at the Tupras oil refinery. It is now important for the Turkish Government to ensure a smooth transition to routine services and to maintain public health measures. The Ministry o f Health has established teams which will ensure that services will be maintained without any interruption. WHO reacted immediately and sent kits for injuries and diseases (diarrhoea and cholera), as well as botulism antitoxin serum. The Director o f Programme Management, WHO Regional Office for Europe (WHO/EURO), went to Turkey just after the earthquake and provided support to the Ministry o f Health in the disaster region in the management and coordination o f the emergency response. An expert on health situations in disasters from WHO headquarters joined the United Nations Disaster Assessment and Coordination (UNDAC) team and contributed to situation and need assessment. For the next phase, WHO will support the regional teams with public health advisers. Four public health advisers and one adviser on psychosocial services have been recruited and they have started to work in the region. WHO/EURO is organizing regular missions to the earthquake area. EUR/RC49/Inf.Doc./6 page 1 T h e E a r t h q u a k e in T u r k e y : It s h e a l t h im p l ic a t io n s 1. On 17 August 1999 at 03:02 a.m. (local time) Turkey suffered the effects o f a devastating earthquake. The epicentre was located near Golcuk, a town near Izmit City in Kocaeli province at the eastern end o f Marmara Sea. Field surveys confirmed that the western part o f the North Anatolian Fault Zone caused the main shock. The earthquake parameters were reported to have different values by different seismological centres. The Earthquake Research Department (ERD) declared the magnitude to be 7.4 - 7.8 on Richter scale. 2. The earthquake occurred after midnight when people were fast asleep. Due to power failure, many cities - and even Ankara - were plunged into complete darkness immediately after the shock. Most people in the country woke up and left their houses immediately. Many buildings collapsed in residential parts o f Istanbul, Kocaeli, Sakarya, Bolu, Yalova, and Bursa provinces. Some casualties were also reported from Eskisehir and Zonguldak provinces, far from the epicentre. The Istanbul-Ankara Expressway was damaged in several locations. Traffic was stopped for two days between Kocaeli and Ankara. Alternative roads were in service but it was impossible to reach the region before the afternoon. The destroyed part o f highway was repaired and traffic resumed its normal pace after six days. A major fire started in the storage tanks o f the TUPRAS petroleum refineiy. Thanks to special aircraft firefighters, this was extinguished after six days. Communication via public telephone lines was interrupted immediately after the quake and cellular phones were also out o f order. 3. According to information from the Crisis Centre in Ankara from 8 September, the death toll from the earthquake was 15 303. A total o f 23 983 injuries have been reported. The death toll is expected to increase considerably due to people being trapped under rubble which has still not been excavated. Actions taken 4. Following the earthquake, various types o f services were immediately carried out. The initial focus was on search and rescue, and transport o f the injured to health care. Search and rescue 5. The earthquake caused serious damage to the residential parts o f the affected towns and city centres. Quite a number o f buildings completely collapsed in Golcuk, Yalova, Adapazari, Izmit, Avcilar, Duzce, Akyazi, Golyaka, Sapanca and Korfez. All collapsed buildings had victims trapped under the debris. People attempted to rescue their relatives and neighbours from the ruins by using their bare hands to dig in the darkness. Volunteer rescue teams arrived in the disaster area in the afternoon. In some areas, rescue operations could only start on the second day due to damage to the highways. Helicopter crews inspected residential areas and the regions were classified for damage assessment. 6. Many countries sent special teams to help in the rescue operations and successfully evacuated thousands o f persons. The availability o f equipment for detecting living persons was also important in the rescue operation. With the help o f such equipment a child was rescued from the ruins nine days after the quake. The search and rescue efforts continued for more than a week with teams from many countries as well as national and voluntary rescue teams. Health services 7. Several hospitals in the earthquake zone suffered major damage. The continuing aftershocks and the fear o f further collapse prevented any in-door medical services, even in buildings which were only slightly damaged. The collapse o f electricity and telephone networks resulted in a lack o f communication between the existing medical facilities. Medical staff too were victims o f the earthquake. Many o f them were buried under the rubble, attempted to rescue their relatives or find them. 8. However, almost all the hospitals in the region were at least partially operational following the earthquake, and started to provide services in the tents. Kartal State Hospital in Istanbul was strengthened and served as a reference centre. Both state and private hospitals provided service for earthquake casualties free o f charge. 9. Local ambulance services were mostly unaffected and ambulances from other cities also joined in transporting casualties. Airborne evacuation by civil and military helicopters was rapidly carried out to transport the injured to hospitals in Ankara, Istanbul and Bursa to back up the field hospitals. 10. After 48 hours, international health teams started to arrive in the region, especially from the International Federation o f Red Cross and Red Crescent Societies and national societies (including American, Austrian, Egyptian, German, Israeli, Japanese, Norwegian and Spanish), Medicins Sans Frontieres, as well as some military health teams. With the assistance received from other countries, medical treatment for injured persons in hospitals is now sufficient. Many supplies were also sent from other countries and from within Turkey to aid the victims o f this catastrophe. Drugs and supplies 11. Since the beginning o f the emergency, the issue has not been a shortage in drugs and supplies, thanks to support from the public and private sector, individual donations and some international aid. 12. The main problem faced has been the lack o f managers capable o f handling such emergency situations. Water and sanitation 13. The water and sewage system was out o f order and a number o f sewage tankers with suction pumps were buried under the rubble. Recognizing the existence o f possible risk factors due to rupture o f water and sanitation infrastructures, and the interruption o f public health services and sanitation measures, the control o f transmission o f epidemic-prone diseases and sanitation services have been o f utmost concern. 14. A rapid assessment o f water pipes and pumps was made, and residential areas and temporary settlements were provided with hyperchlorinated water. All the water tanks coming from other regions were treated with chloride at the entry points to the cities. Despite all these measures, people were also recommended to drink bottled water and the logistics for providing bottled water to the population were ensured. 15. Trash bags were distributed for the collection o f garbage, and the disposal o f garbage was ensured. At the disposal places, disinfecting measures were taken. 16. The US Centers for Disease Control and Public Health Engineers also contributed to an assessment o f temporaiy shelter, sanitation, food and water security and public health in areas where people were camping. Psychosocial services 17. From the third day onwards, psychosocial services were initiated and solidarity units have been established. Some tents were especially arranged as playgrounds for children where they also received psychological support. 18. Besides houses, 258 schools were reported to be damaged. The M inistiy o f Education decided to start schools in the affected area simultaneously with the rest o f the country to draw children away from life among the ruins. Housing 19. The earthquake destroyed the infrastructure o f a large area and left an estimated 300 000 people homeless. Following a phase o f make-shift shelters using household items, tent villages have been set up by local crisis centre authorities for earthquake victims, but most o f them have preferred to remain near their own houses. Tent camps were established with the support o f many countries and organizations EUR/RC49/Inf.Doc./6 page 2 EUR/RC49/Inf.Doc./6 page 3 including the Dutch, German, Greek, Iranian, Swiss and Tunisian Red Cross/Red Crescent societies. The weather conditions have changed to rain, and life continues to be difficult in the region most severely affected. 20. Damage assessment experts continue to do their hard jo b that will result in a final decision concerning the state o f the damaged buildings. The Government has started a construction campaign to produce standard prefabricated houses in a short time with the support o f private companies. The costs o f the reconstruction effort are estimated to be as high as US $20 000 million (10% o f Turkey’s gross national product). Emergency aid to the region 21. The Turkish Government was supported by many other governments, by the International Federation o f Red Cross and Red Crescent Societies, by national Red Cross/Red Crescent societies, by NGOs who sent search and rescue teams, medical personnel, and supplies, including tents and drugs as well as firefighting support to the Tupras petroleum refinery. More than 50 countries supported the region and the number o f staff working in the region has been around 2000. 22. The countries that provided emergency aid include Algeria, Austria, Azerbaijan, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Croatia, Denmark, Egypt, Finland, France, Germany, Greece, Hungary, Israel, Italy, Japan, Kazakhstan, Kyrgyzstan, Lithuania, Mexico, Morocco, the Netherlands, Norway, Pakistan, Poland, Portugal, the Republic o f Moldova, Romania, the Russian Federation, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tunisia, Turkmenistan, Ukraine, the United Kingdom and the United States. The way ahead 23. The emergency response to the earthquake ensured the treatment o f injured people and the establishment o f temporary settlements for the homeless, as well as getting through the first two weeks without any serious public health problem and epidemics. The phase o f relief, rehabilitation and reconstruction has now started. 24. Generally speaking, one week after the impact o f the earthquake, demands for surgery and health care are in theory back to normal. It is now important to ensure a smooth transition to routine services and to maintain the public health measures. There are three areas which will require the utmost attention: • • continuous monitoring and surveillance o f the health problems faced by the earthquake-affected population; • rehabilitation o f physically disabled people; • rehabilitation o f people suffering from mental trauma caused by the disaster. 25. The Ministiy o f Health has established teams to ensure that during the next two months services will be maintained without any interruption. Each team has a region for which it is responsible. The teams include professionals from the region as well as people outside the region who were not affected by the earthquake. These teams have the following responsibilities: • assessing the situation in terms o f buildings, equipment, personnel, supplies, etc., and identification o f needs; • ensuring the transition o f health facilities from an emergency situation to routine work; • ensuring the accessibility o f services; • providing both preventive and curative services; • ensuring rehabilitation services; • ensuring healthy conditions for the infrastructure o f the tent cities; • coordinating all national and international efforts. EUR/RC49/Inf.Doc./6 page 4 26. Each team is comprised o f groups responsible for drugs, inpatient care, health centres, mobile health teams, emergency interventions, environmental health, communicable diseases, and maternal and child health, as well as special interventions such as psychosocial services and services for the disabled and the elderly. 27. Concerning the reconstruction o f health facilities, damage assessment is ongoing and the World Bank and the Government are considering shifting some funds from the ongoing health project loan to the affected area. WHO’s action 28. WHO reacted immediately and sent 10 kits A for injuries and diseases, 2 kits B supporting kits A and 5 kits D for diarrhoea and cholera. Eight bottles o f botulism antitoxin serum were also provided at the initial stage. 29. Dr Serdar Sava?, Director o f Programme Management (DPM), WHO Regional Office for Europe, went to Turkey just after the earthquake (19 August to 5 September) and provided support to the Ministry o f Health in the disaster region in the management and coordination o f emergency response. 30. Dr Noji from WHO headquarters joined the United Nations Disaster Assessment and Coordination (UNDAC) team and contributed to situation and need assessment. 31. The initial assessment showed that there was no lack o f medical personnel, beds and supplies. However, there have been problems due to the lack o f capacity in organizing and coordinating the emergency response. Thus, the area where WHO can best contribute has been identified as coordination and management support, as well as providing a vision for the necessary public health measures. 32. The Ministry o f Health and WHO have agreed that WHO would support the teams established by the Ministry with public health advisers. Thus, four public health advisers and one adviser on psychosocial services have been recruited and have started to work in the region. 33. The advisers will provide support in all the areas o f responsibility o f the regional teams and especially in surveillance; health services need for tent camps; identifying organizational problems; and necessary interventions. They will work full time in the region. This arrangement will be maintained for two months, after which an assessment will be made to decide on further steps to be taken. 34. A mission led by DPM comprising an environmental health specialist and a communicable diseases specialist will go to Turkey and work with the local team from 17 to 22 September 1999.