The inundation of the American southern coastal states by Hurricane Katrina
was described in its first days as a disaster of biblical proportions.
In New Orleans, a city that was 80% underwater, as many as 10,000 people
may have died, according to Louisiana officials. With the water now finally
being pumped away, it has become clear that the terrible human toll of the
devastation was not just due to the unknowable workings of mother nature,
but the result of action, and inaction, by man and his institutions.
In fact, the scope of the destruction
was no surprise; it had been predicted.
The casualties were not equally spread
throughout the population, but were
concentrated on the black and poor.
The failed emergency response was not
due to lack of resources, but to a lack of
coherent planning. The result was a
complete breakdown of the publichealth
infrastructure and civil society.
Ambulance crews were shot at, tourists
were raped in hurricane shelters, and
the elderly and infirm were abandoned
by their caretakers. Emergency response
trauma teams from other states
reported driving hundreds of miles only
to be met with blank stares by uninformed
federal disaster officials.
On the fourth day of the hurricane,
Michael Brown, head of the Federal
Emergency Management Agency, told
CNN that the US Government had only
just learned that thousands of people
were stranded in the New Orleans convention
centre without food or water.
By the weekend, the worlds only superpower
was so overwhelmed by the crisis
that it appealed to the EU for blankets,
tents, and food.
People in the medical and health
professions have got to be stunned
watching people for 5 days without
medical assistance and water, says
Irwin Redlener, director of the National
Center for Disaster Preparedness at the
Columbia University Mailman School of
Public Health.
The victims of the hurricane were
overwhelmingly black and poor. This is
a reflection of the population of New
Orleans and the public health and emergency
systems that failed them, both
before and during the crisis. Now that
the immediate crisis is coming to an
end, that same population will bear the
brunt of the public-health aftermath:
lack of water and food, an absence of
medical care for new and pre-existing
health problems, and infections caused
by the polluted flood waters.
This is the classic public-health vulnerability
of undeserved and disadvantaged
populations, says Redlener. We
are seeing the horrible outcome of a
health and economic system that has
left so many people out.
One of the most dramatic, and horrible,
examples of the inequality of the
disaster was that of Charity Hospital,
where 600 patients and medical staff
were trapped for more than 4 days
behind torrents of sewage and contaminated
water, cut off from electrical
power, clean water, and medical supplies.
While Charity, the largest public
hospital in Louisiana, went without
relief in the days after the hurricane, the
private facility across the street, Tulane
University Medical Center, hired 20 private
helicopters to evacuate its 1400
patients and family members.
The public hospitals, though, were
left to fend for themselves. After 4 days
of isolation, doctors from Charity called
the Associated Press begging for assistance.
We have been trying to call the
mayors office, we have been trying to
call the governors office . . . we have
tried to use any inside pressure we can.
We are turning to you. Please help us,
Norman McSwain, chief of trauma surgery
at Charity Hospital, was quoted
by AP as saying. Another public hospital
a few blocks away, University
Hospital, was similarly left on its own.
Lee Hamm, chairman of medicine at
Tulane University, took a canoe check
on the two public hospitals. Speaking
to AP after the trip, he said: The
physicians and nurses are doing an
incredible job, but there are patients
laying on stretchers on the floor, the
halls were dark, the stairwells are dark.
Of course, theres no elevators. Theres
no communication with the outside
world.
Were afraid that somehow these
two hospitals have been left off . . . that
somehow somebody has either forgotten
it or ignored it or something,
because there is no evidence anything is
being done, said Hamm.
The breakdown of the public-health
infrastructure in the wake of the hurricane
was neither new nor unexpected.
New Orleans residents were accustomed
to living with the prospect of
disastermuch of the city sits below
sea level, protected by a fragile system
of levees, pumps, and canals designed
in the 1960s to withstand a weaker
storm.
Each problem resulting from the
flood was exacerbated by the citys
extreme poverty. 28% of New Orleans
residents live below the poverty line
three times the national averageand
24% of adults are disabled, compared
with 19% nationally.
Government officials had warned
about the disastrous results of a major
storm for years. A particularly detailed
briefing was given 2 years ago by a
group of scientists at the Center for the
Study of Public Health Impacts of
Hurricanes at Louisiana State University
(LSU). Flooding in New Orleans from a
major tropical storm is a disaster waiting
to happen, warned Kevin Robbins
of the Southern Regional Climate
Center.
In a Sept, 2003, briefing, researchers
told local and federal officials, including
representatives of the US Centers
for Disease Control and Prevention
and the Environmental Protection
Agency, that in the event of a major
hurricane, hospitals would be isolated
and that evacuation procedures in
poor areas would fail.
25 hospitals in the New Orleans area
were effectively cut off by floods during
a deluge in 1995, according to research
presented by Jim Diaz, a director of the
Public Health and Preventative Medicine
at the LSU Health Science Center.
Diaz presented research showing that
44% of hospitals cancelled all elective
procedures, cancelling all surgical procedures,
32% had nursing shortages,
25% had doctor shortages, 18% had no
sewage, 11% had no potable water, 7%
had medical supply shortages, and 4%
had food supply shortages.
The failure of evacuation procedures
was also predictedwith low-income
residents being the primary losers.
While 87% of those earning over
US$50 000 said they would evacuate,
only 44% of people earning under
$15 000 said they would leave. That
correlated with the number of people
who owned cars: 74% of those who did
would leave, compared with 50% of
those who did not. And devastatingly,
only 43% of those describing themselves
as in poor health, said they
would leave, as opposed to the
6873% of those in fair health or
better who said they would flee. That
study was based on the preliminary
findings of a study by researchers
based at LSU and at the University of
Calgary, Canada.
In the aftermath of the storm, doctors
moved from patients who had sustained
injuries during the storm to its
after-effects. Now were seeing posttraumatic
stress-type stuff, a lot of
babies with fevers, general viral-type
stuff, and dehydration, George Ward,
director of the emergency room at
Memorial Hospital told The New York
Times.
The problems are compounded by
the vast geographical spread of the
catastrophe, says Redlener. Were not
used to this at all. Normally you have
neighbouring communities that can
help. Now, there is no 911. You have a
situation of the non availability of a
health care system. Its like we are dealing
with medical care of 150 years ago,
he says.
While New Orleans city officials have
expressed concerns about infectious
disease outbreaks caused by the hundreds
of dead bodies decomposing in
the flood waters, public health experts
say that they do not expect such outbreaks
to occur. In the aftermath of similar
disasters, like the Asian tsunami,
episodes of cholera were very limited.
The problems posed by infection
from exposure to the water are very
high, however. Probably the more
immediate health risk to the people is
that whatever was in the sewer is in the
water, John Pardue, director of the
Louisiana Water Resources Research
Institute at LSU in Baton Rouge, told
AP. New Orleans, incidentally, had been
set to host a major infectious-disease
conference this month.
The medium and long term effects of
the disaster are now beginning to play
out. Experts warn that the evacuees
may be cut off from medical care and
drugs are they are moved to makeshift
relocation centres across the country.
What is unfolding now is an absolute
formula for disaster, says Redlener.