GUIDE TO SANITATION IN NATURAL DISASTERS M. ASSAR WORLD HEALTH ORGANIZATION GENEVA 1971 WORLD HEALTH ORGANIZATION The World Health Organization (WHO) is one of the specialized agencies in relationship with the United Nations. Through this organiza­ tion, which came into being in 1948, the public health and medical professions of more than 130 countries exchange their knowledge and experience and collaborate in an effort to achieve the highest possible level of health throughout the world. WHO is concerned primarily with problems that individual countries or territories cannot solve with their own resources-for example, the eradication or control of malaria, schistosomiasis, smallpox, and other communicable diseases, as well as some cardiovascular diseases and cancer. Progress towards better health throughout the world also demands international cooperation in many other activities: for example, setting up international standards for biological substances, for pesticides and for pesticide spraying equip­ ment; compiling an international pharmacopoeia; drawing up and administering the International Health Regulations; revising the inter­ national lists of diseases and causes of death; assembling and dissemi­ nating epidemiological information; recommending non-proprietary names for drugs; and promoting the exchange of scientific knowledge. In many parts of the world, there is need for improvement in maternal and child health, nutrition, nursing, mental health, dental health, social and occupational health, environmental health, public health administra­ tion, professional education and training, and health education of the public. Thus a large share of the Organization's resources is devoted to giving assistance and advice in these fields and to making available-­ often through publications-the latest information on these subjects. Since 1958 an extensive international programme of collaborative research and research coordination has added substantially to knowledge in many fields of medicine and public health. This programme is con­ stantly developing and its many facets are reflected in WHO publications. GUIDE TO SANITATION IN NATURAL DISASTERS GUIDE TO SANITATION IN NATURAL DISASTERS M. ASSAR, M.S.S.E. Under-Secretary of State for Planning and Programmes, Ministry of Health, Teheran, fran WORLD HEALTH ORGANIZATION GENEVA 1971 First impression 1971 Reprinted 1973 Reprinted 1981 © World Health Organization 1971 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. Nevertheless governmental agencies or learned and professional societies may reproduce data or excerpts or illustrations from them without requesting an authorization from the World Health Organization. For rights of reproduction or translation of WHO publications in toto, application should be made to the Office of Publications and Translation, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Director­ General of the World Health Organization concerning the legal status of any country of territory or of its authorities, or concerning the delimitation of its frontiers. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature which are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. PRINTED IN SWITZERLAND CONTENTS Page List of reviewers. 7 Preface . ... 9 1. INTRODUCTION II 2. GENERAL CONSIDERATIONS 14 Definition of natural disasters and emergencies 14 Types of disaster and their results 14 3. EMERGENCY ACTION . 19 Pre-disaster measures 19 Disaster measures 22 Post-disaster measures 22 4. PLANNING AND ADMINISTRATION OF ENVIRONMENTAL HEALTII ACTIVITIES . 23 Co-ordination 23 Planning 24 Organization . 26 Personnel . 28 Equipment and supplies 30 Transport . 31 Living quarters and food supply for relief personnel. 31 Rules and regulations . 32 5. ENVIRONMENTAL HEALTH MEASURES 33 Search, rescue and evacuation 33 Shelter 34 Water supply 36 Waste disposal 62 Food sanitation. 73 Vermin control . 79 Mortuary service and burial of the dead 84 Miscellaneous installations. 85 Education of disaster victims in sanitation 88 6. REHABILITATION AND RECONSTRUCTION. 90 Annex 1. Specimen text for a pamphlet on emergency sanitation at horne . .... .. .' . 93 Annex 2. Relations between the national relief committee and other agencies . 95 -5- Annex 3. Assistance of international agencies 100 Annex 4. Stockpile of equipment and supplies 109 Annex 5. The sanitarian's equipment 111 Annex 6. Summary of sanitation requirements in disasters 113 Annex 7. Urban water supply questionnaire for waterworks super- intendents 116 Annex 8. Disinfection of water mains 121 Annex 9. Useful data for vector control operations 125 LIST OF REVIEWERS Professor P. N. Burgasov, Deputy Minister of Health of the USSR, Moscow, USSR Mr A. Eshete, Director-General, Division of Environmental Health, Ministry of Public Health, Addis Ababa, Ethiopia Professor R. Geric, Vice-President, Federal Council for Health and Social Affairs, Belgrade, Yugoslavia Dr G. Wynne Griffith, Principal Medical Officer, Department of Health and Social Security, London, England Dr Z. S. Hantchef, Medical Director, League of Red Cross Societies, Geneva, Switzerland Dr M. Hashimoto, Chief, Environmental Pollution Control, Ministry of Health and Welfare, Tokyo, Japan Mr C. C. Johnson, jr, Assistant Surgeon General and Administrator, Consumer Protection and Environmental Health Service, US Public Health Service, Washington, D.C., USA Dr F. Rizk Hassan, Under-Secretary of State, Ministry of Public Health, Cairo, United Arab Republic Dr M. l. Sheikh, Professor of Civil Engineering, University of Engineering and Technology, Lahore, Pakistan Dr J. M. Ugarte, Professor, Faculty of Medicine, University of Chile, and Adviser in Health Planning, Ministry of Public Health, Santiago, Chile -7- PREFACE For some time the World Health Organization has been concerned about the lack of practical information and recommendations concerning environ­ mental sanitation in emergencies and natural disasters. Hardly any systematic studies of the question have been made, and there are few countries where standing instructions have been issued on environmental sanitation under disaster conditions or where emergency sanitation supplies and equipment have been prepared and stockpiled. When disasters occur, there is an urgent need for technical information on emergency procedures for water supply, disposal of excreta and other wastes, food and milk sanitation, disinfection and disinfestation, and the rapid control of flies, mosquitos, rats, and other insect and rodent pests. In the early stages of a disaster, much confusion and delay can be avoided if the staff in charge of sanitation relief know exactly what to do to remedy the most serious damage promptly and efficiently. It is clear that these needs cannot be met without careful planning and long preparation by the health authorities. Relief workers need to be given simple and practical instructio'1S on how to perform their tasks under the abnormal and hazardous conditions created by a catastrophe. As each disaster has its own characteristics, and as each country has varying means and resources at its disposal, it is impossible to recommend specific measures that are applicable to all emergencies everywhere. Never­ theless, certain elements of emergency sanitation are common to most natural disasters. This Guide provides basic information on the principles of emergency sanitation and contains detailed instructions for carrying out certain tasks. It is intended primarily to assist health authorities and relief agencies in developing their relief plans and in preparing themselves to cope efficiently with the sanitation problems caused by a disaster. The author has long and outstanding experience in emergency sanitation practice; as Director-General of the Division of Sanitary Engineering in the Ministry of Health of Iran he was responsible for all environmental health relief to victims of floods and earthquakes. A first draft of this Guide was circulated to a number of experts in different parts of the world for their comments and suggestions, which have been taken into account in preparing the final text. A list of these reviewers will be found on page 7. The League of Red Cross Societies-the world federation of national Red Cross Societies-has collaborated in this project since its inception. -9- The League's wide experience in the provision and co-ordination of emergency aid for victims of disasters, its assistance in obtaining documents issued by national Red Cross Societies, and its wise advice and sound recommendations have been extremely helpful in the preparation of this Guide. The World Health Organization expresses its sincere gratitude to the League oIRed Cross Societies, to the reviewers, and particularly to the author, Mr M. Assar. -10 - 1. INTRODUCTION Despite the tremendous achievements of modern technology mankind remains virtually helpless in the face of such natural disasters as floods, hurricanes, volcanic eruptions, and earthquakes, which attack populated centres and