ADC Online First, published on February 24, 2011 as 10.1136/adc.2009.178145 Leading article Arch Dis Child: first published as 10.1136/adc.2009.178145 on 22 September 2010. Downloaded from

disorder (PTSD). 13 Children appear to be H u r r i c a n e s a n d c h i l d h e a l t h : more prone to PTSD than adults follow- ing natural disasters. 12 The prevalence of PTSD appears to be related to the lessons from Cuba severity of the natural disaster and the proximity of the child or adolescent to 1 2 12 D e y b i s S á n c h e z M i r a n d a , I m t i C h o o n a r a the event. Studies in children follow- ing hurricanes have shown the preva- lence rate of PTSD has ranged from 7% HURRICANES during the recovery phase. Drowning to 90% in severely affected regions in A hurricane is a large rotating storm with a during the hurricane used to account for Nicaragua following hurricane Mitch. 14 central area of very low pressure and strong the majority of the deaths. The use of The symptoms of PTSD can be present winds greater than 74 mph (118 km/h). 1 warning systems combined with evacu- for a long period after the hurricane; The hurricane is graded 1–5 in relation to ation has, however, dramatically reduced 12% children had severe symptoms the strength of the winds, which can be drowning deaths. 1 3 During hurricane of PTSD 10 months after hurricane greater than 155 mph (249 km/h, category Katrina, however, two-thirds of the Andrew. 15 It is important therefore to 5). 2 Hurricanes arise from warm, moist fatalities were thought to be due to the recognise that the health effects of hur- air from tropical oceans, and with global direct physical effects of the fl ood, and ricanes can last well beyond the initial warming, hurricanes are occurring more the majority of the deaths were thought period of impact. frequently and with greater severity. 3 to be due to drowning. 6 The high num- Tropical storms originating in the Atlantic ber of deaths due to drowning follow- Ocean or the Eastern North Pacifi c Ocean ing hurricane Katrina was probably C U B A (ie, the Northern hemisphere) are termed associated with the inadequate evacua- In the summer of 2008, over a period hurricanes, whereas those that origi- tion and preparation of the population. 7 of 3 weeks, two category 4 hurricanes nate from the Pacifi c Ocean are known Hurricanes also cause death by physical (Gustav and Ike) caused over 200 deaths 16 17 as typhoons and those from the Indian damage to buildings and trees, which in the Caribbean and the USA. The Ocean as cyclones. 1 Hurricanes are a major may result in direct trauma. The most two hurricanes were at their greatest problem for countries in the Caribbean frequent injuries following hurricanes intensity (category 4) in Cuba and caused and Central and Latin America. The word are cuts, lacerations, puncture wounds widespread destruction to buildings, ‘hurricane’ is thought to be derived from and blunt trauma caused by fl ying glass livestock and crops. Hurricane Ike alone 17 either the Carib god ‘Hurican’ or the and other debris. 1 8 damaged over 300 000 homes in Cuba. Mayan god ‘Hurakan,’ who caused a great There are signifi cant health effects after Extensive damage to crops has been storm and fl ood by blowing his breath the hurricane when there may be a lack of reported, and the economic cost to Cuba 17 across the ocean. 4 clean water, food and housing as well as has been estimated as US$3–4 billion. access to healthcare. The lack of provision The two hurricanes were of far lower

intensity (categories 1 and 2) when they http://adc.bmj.com/ HEALTH EFFECTS of these essential items undoubtedly con- passed through Haiti and the USA. It has been estimated that almost two tributed to the signifi cant mortality fol- 9 10 Despite the fact that Cuba experi- million people worldwide have died from lowing hurricane Katrina. Infectious enced the hurricanes at their greatest tropical storms (hurricanes, typhoons diseases may increase dramatically fol- intensity, there were only seven deaths and cyclones) in the last two centuries. 1 lowing a tropical storm. This increase in throughout Cuba. 16 17 In contrast, there In the 20th century alone, there have infectious diseases is more likely to occur were over 100 deaths in Haiti and over been 75 000 deaths from hurricanes in low- and lower-middle income coun- 30 in the USA. 16 17 Over the last 50 years, on September 24, 2021 by guest. Protected copyright. in North America and the Caribbean, tries. Damage to water and sanitation Cuba has managed to reduce signifi - including almost 10 000 deaths from networks, alongside pools of stagnant cantly the number of deaths following hurricane Mitch, which affected Central water following fl ooding, may result in hurricanes. 18 19 Hurricane Flora in 1963 America in 1998. 5 a signifi cant increase in cases of gastro- resulted in the deaths of over 1200 peo- The impact of hurricanes on health enteritis and other infectious diseases. ple in Cuba. 18 Since then, Cuba has intro- can be divided into immediate and Hurricane Mitch resulted in increases in the number of cases of cholera, lep- duced early warning systems alongside tospirosis, dengue and malaria in sev- evacuation. Hurricane Ike passed directly 1 Children’s Hospital, Camagüey, Cuba eral of the affected countries. 5 Shelter through the Province of Camagüey, and 2 Academic Division of Child Health, University of for families who have been evacuated the steps taken to protect the health of Nottingham, Derbyshire Children’s Hospital, Derby, UK or whose homes have been destroyed is children and adults are important for Correspondence to Professor Imti Choonara, critical for survival. Fatalities following other countries. Academic Division of Child Health, The Medical School, University of Nottingham, Derbyshire the cyclone in Bangladesh in 1991 were Children’s Hospital, Uttoxeter Road, Derby DE22 3DT, signifi cantly higher in areas where shel- WARNING AND PREPARATION U K ; i m t i . c h o o n a r a @ n o t t i n g h a m . a c . u k ter was not provided. 11 Because hurricanes originate in the mid- There is increasing recognition that dle of oceans, it is several days before following hurricanes and other natu- the hurricane reaches land, and this ral disasters, there may be signifi cant allows governments to take action to mental health problems. 12 The most fre- protect human life. Cuba has an excel- quent psychological disorder following lent meteorological institute which, in natural disasters is post-traumatic stress conjunction with US scientists, projects

CopyrightMiranda DS, Article Choonara author I. Arch Dis (orChild their(2010). doi:10.1136/adc.2009.178145employer) 2011. Produced by BMJ Publishing Group Ltd (& RCPCH) under 1licence. of 2 Leading article Arch Dis Child: first published as 10.1136/adc.2009.178145 on 22 September 2010. Downloaded from the likely paths of hurricanes. The ben- were visited in their homes by the fam- REFERENCES efi ts of universal education and eradica- ily doctor, nurse or other health profes- 1 . Shultz JM, R u s s e l l J , E s p i n e l Z . E p i d e m i o l o g y tion of illiteracy are that the population sional. This was only possible because of tropical cyclones: the dynamics of disaster, disease, and development. Epidemiol Rev is aware of the risks associated with Cuba has one of the best primary 2005 ; 27 : 2 1– 3 5. hurricanes and understands government healthcare systems in the world with 2 . National Hurricane Center. http://www.nhc. warnings. The importance of issuing the highest ratio of doctors per capita noaa.gov/pdf/NWS-TPC-5.pdf (Accessed 15 early warnings to the population cannot worldwide. 21 22 Each family doctor and December 2009). 3 . Ebi KL, Schmier JK. A stitch in time: improving be overemphasised and has been shown nurse is responsible for between 120 public health early warning systems for extreme to be effective in reducing deaths for a and 160 families. Health professionals weather events. Epidemiol Rev 2 0 0 5; 27 : 115 – 21 . variety of extreme weather events. 3 It is kept a special lookout for mental health 4 . National Oceanic and Atmospheric important to recognise that Cuba has a problems in children following the hur- Association . Hurricane Research Division http:// population with a very high level of civil ricane, as it is recognised that these are www.aoml.noaa.gov/hrd/tcfaq/B4.html (Accessed 27 January 2010 ). 23 participation. The majority of the popu- signifi cant problems. 5 . Pan American Health Organization. Impact of lation are members of different mass hurricane Mitch on Central America. Epidemiol Bull organisations, and there is a strong sense C O N C L U S I O N S 1998 ; 19: 1 – 13 . of community spirit. 6 . Jonkman SN, M a a s k a n t B , B o y d E , et al. L o s s o f The economic damage caused by hur- life caused by the fl ooding of New Orleans after Hurricane awareness is taught in ricanes Gustav and Ike (two category Hurricane Katrina: analysis of the relationship schools, and 72 h prior to a hurricane, four hurricanes) to Cuba was substan- between fl ood characteristics and mortality. national media issue alerts are given while tial. However, by a combination of Risk Anal 2 0 0 9; 29 : 676 – 98 . 7 . Susman J. A case that’s black and white: the civil protection committees check evacu- early warnings and preparation along- ation plans and shelters. 20 Following hur- price of being poor and African American in New side the evacuation of almost a quarter Orleans. J Fam Pract 2 0 0 5; 54 : 832 . ricane Dennis in 2005, which resulted in of the population of Cuba, only seven 8 . Linscott AJ. Natural disasters—a microbe’s 17 deaths within Cuba, a greater aware- lives were lost (box 1). Both Jamaica and paradise. Clin Microbiol Newsl 2 0 0 7; 29 : 5 7– 6 2. ness of the risks associated with hurri- the Dominican Republic have used the 9 . Ferdinand KC. Public health and Hurricane Katrina: lessons learned and what we can do now. canes has been emphasised to the Cuban mass media in a similar manner to Cuba 19 J Natl Med Assoc 2 0 0 6; 98 : 271 – 4 . population. Forty-eight hours prior to to try and increase awareness among 1 0 . Atkins D, Moy EM. Left behind: the legacy of the hurricane, authorities inform high- individuals of the dangers associated hurricane Katrina. BMJ 2 0 0 5; 331 : 916 – 18 . risk areas and evacuation commences. with hurricanes and how appropriate 1 1 . Bern C, Sniezek J, Mathbor GM, et al. Risk factors for mortality in the Bangladesh cyclone of 1991. Prior to hurricane Ike, 2.6 million people preparation can reduce casualties. 20 (23% of the population of Cuba) were Bull World Health Organ 1 9 9 3; 71: 73 – 8 . Equally important as preparation prior 1 2 Sundram S, Karim ME, Ladrido-Ignacio L, et al. 17 evacuated and housed in shelters. to the hurricane is ensuring the provi- Psychosocial responses to disaster: an Asian sion of shelter, food and water along- perspective. Asian J Psychiatr 2 0 0 8; 1 : 7 – 14 . PREPARATION IN CAMAGÜEY side healthcare after the hurricane for 1 3 . Norris FH, F r i e d m a n M J , W a t s o n P J , et al. 6 0 , 0 0 0 disaster victims speak: Part I. An empirical review PROVINCE all individuals in affected areas (box 1). of the empirical literature, 1981-2001. Psychiatry Prior to the hurricane reaching This should be provided by the gov- 2002 ; 65 : 207 – 39 .

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2 of 2 Miranda DS, Choonara I. Arch Dis Child (2010). doi:10.1136/adc.2009.178145