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Health Experts Warn Death Toll From Disease Could Hit 50,000

December 29, 2004 at 12:00 AM EDT


MARGARET WARNER: Dr. Nabarro, welcome. Since you made that statement yesterday, the death toll has risen to, as we speak now, 80,000 and still rising.

Do you think that many people are at risk of dying from disease?

DR. DAVID NABARRO: No, and indeed it will be an absolute tragedy if it was, but there’s a pretty good chance that as many as 50,000 could die of disease.

And my reasoning is this: There are at least five million people in the region who are now homeless, who don’t have access to drinking water, who lack food and who lack proper shelter.

They’re unable to access functioning health services because the health systems have been badly damaged or even destroyed.

MARGARET WARNER: Explain for us in greater detail. We keep hearing the risk of contaminated water is the greatest.

How would a tsunami coming in once or maybe twice and then leaving lead to this terrible problem of contaminated water?

DR. DAVID NABARRO: The water supplies on which people depend are precarious anyway.

They are taking water from wells or they’ve got very rudimentary piped water supplies.

They are… the water is coming from collection points which may well be have very limited protection against the outside.

The tsunamis have come in like a force of many bulldozers and just simply smashed piping, well structures and other facilities that would normally be used to keep the existing water supplies protected from environmental contamination.

That’s contamination with fecal material or other potential causes of disease.

DR. DAVID NABARRO: Now, what we find in these kinds of crises is that when these relatively fragile water systems are damaged, that people do not have clean water sources, and they take water from wherever they can get it, and that will very likely be contaminated with fecal material, and therefore there will be a risk, quite a high risk, of the ingestion of bacteria.

Remember that these are communities where the quality of water that’s normally used is not very good, so, therefore, it will worsen, be worsened as a result of the tsunamis and the earthquake.

MARGARET WARNER: So what diseases are at greatest risk of developing?

DR. DAVID NABARRO: The most likely diseases in the first instance are diarrheal disease, and what we will see is an exacerbation of the normal pattern of diarrhea that is particularly commonly seen in poorer families.

It won’t be a massive outbreak again unless we’re very unlucky. But then gradually, unless we can improve water supplies and also ensure decent sanitation, we will see a gradually increasing level of these conditions.

And, again, if we can’t ensure proper treatment quickly and promptly, then what we call the case fatality rate from these diseases will also be comparatively high, and we’ll start to see climbing death rates.

MARGARET WARNER: There has been some confusion about whether unburied corpses pose a danger to the survivors. What’s the truth there?

DR. DAVID NABARRO: Our position, based on the data that we have available, is that unburied corpses do not pose a danger to the health of survivors in communities.

Yes, they’re unsightly, and they give off odors which people find offensive.

MARGARET WARNER: So… first of all, are you getting any reports from the field already of any cases of disease? I think I read today that Sri Lanka was reporting some diarrhea, some malaria. What are you hearing?

It’s also very disturbing to a community to see dead people in large number in their communities.

But it’s not essential to rush to bury these corpses for public health purposes. They’re not a primary cause of disease.

DR. DAVID NABARRO: Yes, I have heard the same information that you have heard. I’m expecting tomorrow morning a more detailed report from our team in Sri Lanka, who are in the process of setting up a rapid surveillance system precisely to track possible increases in diarrhea.

In malaria also we’re expecting increases, though we’d not expect them to come quite this quickly after a disaster. That’s something we’d expect in a month or so.

So we need to check this out. But I am not surprised.

This is about the time I would be expecting to begin to see increases in diarrhea particularly, and it shows how prompt we have to be with ensuring that water purification or other measures are put in place and necessary treatment facilities are set up.

MARGARET WARNER: So, is the focus on shipping in water itself, bottled water and tanks of water, or it is in bringing in the kind of equipment that enables people to purify their own water, or is it in getting teams in to repair the sewer and water systems?

DR. DAVID NABARRO: Yes, and it’s all of those.

Firstly, the absolute requirement now is that communities have bottles of water purification tablets so that they can put these tablets into their drinking water and then be certain that when they drink it they’re not going to be ingesting lethal bacteria.

Unfortunately, the water purification tablets make the water taste like water from a swimming pool. It’s very chlorinated, and not many people enjoy drinking that, so they try, if possible, to avoid it.

The second requirement is to try to tanker in clean water, and that’s already starting in Sri Lanka and in parts of India and I’m sure we’ll see it.

It’s already happening, I just don’t know for sure, in Indonesia.

The tankering means that you bring in clean water and then you make sure that it’s either put into bladder tanks, which then are connected to faucets from which people can take the water, or you put the tanker in a particular place and then people know that they can go at a time of day and get clean water.

MARGARET WARNER: Dr. David Nabarro, thank you for joining us.

DR. DAVID NABARRO: And thank you. It was my pleasure.