Beyond the rubble: Tony Redmond on the aftermath of the Turkey-Syria earthquake

The death toll from the earthquakes that have afflicted Turkey and Syria has shocked the world. Such is the magnitude of the disaster and the scale of devastation spread across so wide an area it has clearly initially overstretched what are usually thought to be the considerable disaster response capacities of a country like Turkey.

The search and rescue phase continues, but this is already beginning to morph into a recovery of the dead; although rescue workers will continue for some time yet in the hope that somebody in the rubble lying uninjured but unable to free themselves, can be found and released.

In practice, there is a relatively small window to rescue large numbers of people, as injured people trapped in collapsed buildings cannot survive very long without rescue and medical care. Those trapped but uninjured may last longer, but of course cannot last for too long without water. But the recovery of the dead is but an indicator of the much wider problem the Turkish and international communities now face.

It is known that for every person who dies in an earthquake there may be three or four severely injured survivors.

These will have injuries, that although not immediately life threatening, will become life threatening if they do not receive the medical and surgical care that will prevent them from developing deadly infections and multiple organ failure.

Also neglected, or inadequately treated, injured limbs eventually become unsalvageable and amputations that might have been avoided become inevitable. There will therefore be a large amount of surgery to be carried out in the coming weeks, and extensive rehabilitation, both of individuals and of health systems, will be required in the coming months.

Whilst the search and rescue window might appear to be starting to close, the medical aid window is opening wider. Field hospitals are being deployed where existing facilities have been destroyed or severely incapacitated. Additional nurses and doctors are also required to work in existing or relatively undamaged facilities.

Mobile clinics may well be deployed to the more remote areas to assess the health care needs of the population and report back to the coordination centre. But also, to provide immediate medical care to those injured but not requiring hospital treatment, and to deal with any other coincidental healthcare needs.

When disaster strikes the attention is obviously on the immediate consequences which in an earthquake is the huge caseload of severely injured patients. But these disasters have a long tail. The follow up and rehabilitation of these patients will last for months and for some it will last for years.

Injuries may lead to difficulty in walking which will need extensive physiotherapy and those who have unfortunately lost limbs will require prostheses. Earthquakes can produce large numbers of spinal cord injuries that will require lifelong healthcare input. Much rehabilitation and support can eventually be given in a patient’s home when healthcare workers demonstrate specific techniques to relatives and show them how best to care for patients in the longer term, and how to avoid harmful complications.

After disasters such as this people seek medical care and reassurance and the provision of healthcare clinics is very important as part both of the immediate response, but also the longer term follow up. The disruption to everyday health care will be significant. Antenatal care, obstetric care, neonatal care and paediatrics are all affected; as is the medical support to those with chronic illness.

The demands are enormous and must be factored into the international aid response. Patients lose their medication in the rubble which then must be repurchased and replaced. Within these mobile clinics can also be incorporated psychological support, ideally from local psychologists (with international help if required). People are bereaved and traumatised and the psychological burden is considerable. Restoration of as normal a life as possible has obvious benefits, but the physical, emotional, and psychological consequences of this will last a lifetime.

As well as meeting the immediate medical needs of survivors, the rapid restoration of damaged infrastructure is also required to prevent further avoidable loss of life. Clean water, sanitation, food, shelter, and healthcare are the foundations cornerstones of any safe society, and all these have been lost or disrupted by this terrible earthquake. WHO has warned that such damage may yet pose as great a threat to life as the earthquake itself.

UK-Med will play its part in supporting colleagues in Turkey and Syria in addressing both the immediate needs of these stricken people and helping to reduce the impact of the secondary and longer term threats to health caused by this disaster.

To support the Turkey-Syria Appeal, please donate here.

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