Cyclone Idai and the Importance of Public Health Preparation

Cyclone Idai devastated Mozambique, Zimbabwe, Malawi, and Madagascar as it tore a path through South-Eastern Africa between the 4^th and 21^st March 2019. It was one of the worst cyclones ever to affect the southern hemisphere, with an estimated 1.7 million people directly affected by the storm and over $1 billion in damage caused. Flooding in the immediate aftermath caused the majority of deaths in Mozambique and Zimbabwe, and the overwhelming destruction led to a revised appeal on behalf of IFRC to cover the cost of the immense scale of the response.

Although the flood waters have now long subsided, the true magnitude of the disaster is still yet to be fully understood. Recent reports from agencies active on the ground in Beira, one of the worst-affected areas, have raised concerns over the potential for tremendous health crises in Idai’s wake.

Cases of cholera were reported in Beira just a week after Idai made landfall, as a result of water being contaminated by sewage in the flooding. By 4^th April, there were an estimated 4,000 cases of cholera in and around Beira, resulting in at least 7 deaths. Medecins sans Frontieres reported an estimated 200 new cases per day at the height of the response, with the Red Cross describing the threat of further outbreaks as a “ticking bomb”. Though cholera currently appears to be the biggest health threat to victims of Idai, a severe lack of clean drinking water means threats of typhoid and other diarrheal diseases remain high. The stagnant flood water also acts as a prime breeding ground for mosquitoes and other vectors, leading to an increased risk of malaria, which has seen 276 new cases reported in Mozambique as of 2^nd April.

These emerging health crises have been exacerbated by the massive damage to infrastructure in Beira and other severely affected areas. Beira’s main hospital suffered serious damage in the storm, leaving several of its operating theatres unusable, and an estimated 55 other health centres across Mozambique were affected. International NGOs and the World Health Organisation have responded quickly to try to plug the gaps, with the WHO distributing nearly 900,000 cholera vaccines and MSF doubling down on its programmes in the affected region, but the spiralling health implications of Idai are simply too large to contain completely.

As the recent Preventionweb report on Idai’s health consequences reports, the interruption of health services for communicable and non-communicable diseases is another major concern in affected communities. Mozambique has around 2.1 million HIV patients, many in hard-to-reach communities that may no longer have access to antiretroviral drugs. Similarly, those who require medications for long-standing diseases such as hypertension, diabetes, and tuberculosis are facing medical shortages. The World Health Organisation, alongside many other international actors, are also increasingly focusing their attention on the treatment of the mental health consequences of disasters, which can have catastrophic effects on the development and resilience of affected communities.

The longer-term health implications of Idai are proving to be more destructive than the storm itself. The spiralling risk of epidemics, dramatic loss of health infrastructure in-country, and poorly understood mental health effects of a disaster like Idai demonstrate the importance of viewing disaster response through a public health lens. Medical assistance is one of the key life-saving priorities both in the immediate response phase and as affected populations start to rebuild their lives. Effective health and sanitation programmes make the difference between a one-off destructive natural event and a protracted, complex humanitarian crisis.

But as the scramble to find increased funds to meet the needs of the population also shows, a key focus for the future of disaster management needs to be in preparation and prevention, rather than in response. The speed with which the WHO was able to distribute almost 900,000 cholera vaccines was possible thanks to the Oral Cholera Vaccine Stockpile, administered by an international coordinating group and organised in preparation for quick response in areas at risk of epidemic. Around the world, hospitals and health providers are developing emergency preparedness plans to ensure they are able to continue working during and after a crisis. As the humanitarian sector more widely continues to acknowledge the importance of preparation in ensuring effective response, the factors that contribute to a resilient health system in developing countries must take priority.

IFRC estimates that for every $1 spent on preparation, up to $4 can be saved in recovery. The almost unprecedented fury of Cyclone Idai helped to demonstrate the snowball implications of a hazard that strikes an unprepared community. Building resilience to future disasters does not just mean building stronger structures (though that is obviously extremely important), but developing strategies to cope with disasters at a local level, implementing preparedness plans, engaging in health education and ensuring that at-risk communities know what to expect and where to go to get help in the event of a crisis, long before it occurs.

With climate change increasing the likelihood of more frequent and more destructive weather patterns globally, the need to make sure that everybody is prepared becomes increasingly pressing. When a system is vulnerable to disaster, threats can multiply exponentially. A compromised healthcare system has knock-on effects on those who may not have been affected by the initial event itself.

Disaster response must focus on long-term resilience as well as immediate life-saving care. It is not easy, but building long-term resilience will save money, time, and ultimately lives.

Building local communities’ resilience to disasters is a key focus of the Agenda for Humanity and of the Sendai Framework for Disaster Risk Reduction. Viewing disasters through a holistic lens can help to identify vulnerabilities to be addressed, and also potential partnerships between sectors to tackle complex crises around the world.

QSAND is a shelter and settlement sustainability tool that provides a holistic framework to support resilient reconstruction following disasters.