Box 82 Gender and natural disasters

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Men and women are affected differently in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction (Fothergill, 1998). Natural disasters have been shown to result in increased domestic violence against, and post-traumatic stress disorders in, women (Anderson and Manuel, 1994; Garrison et al., 1995; Wilson et al., 1998; Ariyabandu and Wickramasinghe, 2003; Galea et al., 2005). Women make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery (Enarson and Morrow, 1998; Ariyabandu and Wickramasinghe, 2003). After the 1999 Orissa cyclone, most of the relief efforts were targeted at or through women, giving them control over resources. Women received the relief kits, including house-building grants and loans, resulting in improved self-esteem and social status (BriceƱo, 2002). Similarly, following a disastrous 1992 flood in Pakistan in the Sarghoda district, women were involved in the reconstruction design and were given joint ownership of the homes, promoting their empowerment.

have been reported in low- and middle-income countries. Flood-related increases in diarrhoeal disease have also been reported in India (Mondal et al., 2001), Brazil (Heller et al., 2003) and Bangladesh (Kunii et al., 2002; Schwartz et al., 2006). The floods in Mozambique in 2001 were estimated to have caused over 8,000 additional cases and 447 deaths from diarrhoeal disease in the following months (Cairncross and Alvarinho, 2006).

The risk of infectious disease following flooding in high-income countries is generally low, although increases in respiratory and diarrhoeal diseases have been reported after floods (Miettinen et al., 2001; Reacher et al., 2004; Wade et al., 2004). An important exception was the impact of Hurricanes Katrina and Rita in the USA in 2005, where contamination of water supplies with faecal bacteria led to many cases of diarrhoeal illness and some deaths (CDC, 2005; Manuel, 2006).

Flooding may lead to contamination of waters with dangerous chemicals, heavy metals or other hazardous substances, from storage or from chemicals already in the environment (e.g., pesticides). Chemical contamination following Hurricane Katrina in the USA included oil spills from refineries and storage tanks, pesticides, metals and hazardous waste (Manuel, 2006). Concentrations of most contaminants were within acceptable short-term levels, except for lead and volatile organic compounds (VOCs) in some areas (Pardue et al., 2005). There are also health risks associated with long-term contamination of soil and sediment (Manuel, 2006); however, there is little published evidence demonstrating a causal effect of chemical contamination on the pattern of morbidity and mortality following flooding events (Euripidou and Murray, 2004; Ahern et al., 2005). Increases in population density and accelerating industrial development in areas subject to natural disasters increase the probability of future disasters and the potential for mass human exposure to hazardous materials released during disasters (Young et al., 2004).

There is increasing evidence of the importance of mental disorders as an impact of disasters (Mollica et al., 2004; Ahern et al., 2005). Prolonged impairment resulting from common mental disorders (anxiety and depression) may be considerable. Studies in both low- and high-income countries indicate that the mental-health aspect of flood-related impacts has been insufficiently investigated (Ko et al., 1999; Ohl and Tapsell, 2000; Bokszczanin, 2002; Tapsell et al., 2002; Assan-arigkornchai et al., 2004; Norris et al., 2004; North et al., 2004; Ahern et al., 2005; Kohn et al., 2005; Maltais et al., 2005). A systematic review of post-traumatic stress disorder in high-income countries found a small but significant effect following disasters (Galea et al., 2005). There is also evidence of medium-to long-term impacts on behavioural disorders in young children (Durkin et al., 1993; Becht et al., 1998; Bokszczanin, 2000, 2002).

Vulnerability to weather disasters depends on the attributes of the person at risk (including where they live, age, income, education and disability) and on broader social and environmental factors (level of disaster preparedness, health sector responses and environmental degradation) (Blaikie et al., 1994; Menne, 2000; Olmos, 2001; Adger et al., 2005; Few and Matthies, 2006). Poorer communities, particularly slum dwellers, are more likely to live in flood-prone areas. In the USA, lower-income groups were most affected by Hurricane Katrina, and low-income schools had twice the risk of being flooded compared with the reference group (Guidry and Margolis, 2005).

High-density populations in low-lying coastal regions experience a high health burden from weather disasters, such as settlements along the North Sea coast in north-west Europe, the Seychelles, parts of Micronesia, the Gulf Coast of the USA and Mexico, the Nile Delta, the Gulf of Guinea, and the Bay of Bengal (see Chapter 6). Environmentally degraded areas are particularly vulnerable to tropical cyclones and coastal flooding under current climate conditions.

8.2.3 Drought, nutrition and food security

The causal chains through which climate variability and extreme weather influence human nutrition are complex and involve different pathways (regional water scarcity, salinisation of agricultural lands, destruction of crops through flood events, disruption of food logistics through disasters, and increased burden of plant infectious diseases or pests) (see Chapter 5). Both acute and chronic nutritional problems are associated with climate variability and change. The effects of drought on health include deaths, malnutrition (undernutrition, protein-energy malnutrition and/or micronutrient deficiencies), infectious diseases and respiratory diseases (Menne and Bertollini, 2000).

Drought diminishes dietary diversity and reduces overall food consumption, and may therefore lead to micronutrient deficiencies. In Gujarat, India, during a drought in the year 2000, diets were found to be deficient in energy and several vitamins. In this population, serious effects of drought on anthropometric indices may have been prevented by public-health measures (Hari Kumar et al., 2005). A study in southern Africa suggests that HIV/AIDS amplifies the effect of drought on nutrition (Mason et al., 2005). Malnutrition increases the risk both of acquiring and of dying from an infectious disease. A study in Bangladesh found that drought and lack of food were associated with an increased risk of mortality from a diarrhoeal illness (Aziz et al., 1990).

Drought and the consequent loss of livelihoods is also a major trigger for population movements, particularly rural to urban migration. Population displacement can lead to increases in communicable diseases and poor nutritional status resulting from overcrowding, and a lack of safe water, food and shelter (Choudhury and Bhuiya, 1993; Menne and Bertollini, 2000; del Ninno and Lundberg, 2005). Recently, rural to urban migration has been implicated as a driver of HIV transmission (White, 2003; Coffee et al., 2005). Farmers in Australia also appear to be at increased risk of suicide during periods of drought (Nicholls et al., 2005). The range of health impacts associated with a drought event in Brazil are described in Box 8.3.

823.1 Drought and infectious disease

Countries within the 'Meningitis Belt' in semi-arid sub-Saharan Africa experience the highest endemicity and epidemic frequency of meningococcal meningitis in Africa, although other areas in the Rift Valley, the Great Lakes, and southern Africa are

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