How well prepared is the public health system in Odisha to tackle natural disasters?

“Welcome to the land of cyclone Fani”. “Oh! You are in time for the cyclone season”. These are not unexpected greetings in this corner of the world.

After all, the east Indian state of Odisha has made headlines in the last 20 years for cyclones that ravaged the coastal state, even as recently as May 3, 2019, when Fani, a “rarest of the rare” summer cyclone pummeled the state.

Home to 46 million people, Odisha is often referred to as the disaster capital of the country, for the deadly cocktail of floods, cyclones, and droughts that regularly ravages it. The devastating cyclone Fani clinched a spot among 2019 “high impact” events as announced by the World Meteorological Organisation at 25th iteration of the United Nation’s Conference of Parties (COP 25).

Of the 1019 cyclonic disturbances the Indian subcontinent experienced in the last century, 890 impacted the eastern coast and 129 hit the western coast. As many as 260 cyclonic disturbances had their landfall along the Odisha coast in east India.

The defining moment for disaster management in Odisha came when the 10,000 deaths in the 1999 super cyclone prompted the state to launch a dedicated disaster management authority, an autonomous body. It became the first state in India to do so, saving lives in subsequent disasters and then winning global laurels for its work. Disaster management systems were also aligned with health systems in Odisha, where out of 30 districts of the state, 14 districts are categorised as high damage risk zone, as per the state’s wind and cyclone hazard zones map.

“For example, evacuating pregnant women to shelters on a priority basis during disasters, especially cyclones, is being done consistently and efficiently. Distribution of chlorine tablets to disinfect water, antibiotics and antipyretics, has had positive impacts in controlling infections,” said Shridhar Kadam, Associate Professor, Indian Institute of Public Health-Bhubaneswar.

“The government have also managed to lessen the damage from physical injuries that occur from property destruction during the cyclone event,” Kadam told Mongabay-India.

However, Kadam, as well as other experts, feel with increasing frequency of extreme weather events and emerging health issues, it is time to up the ante.

“In the case of cyclones, early warning systems prevented large scale death and disease in recent years. What happens in case of earthquakes or flash floods,” questioned Kadam, adding that health system readiness must be customised for each category of disaster.

“Rapid Response Teams that cater to each disaster and have updated knowledge on health systems aligned to that specific event will markedly improve readiness,” he said.

Preparing for disasters in the context of health

Odisha’s list of state-specific disasters includes lightning, heatwave, tornado, heavy rainfall and snakebites (other than during flood) in addition to nationally-declared disaster (earthquake) and others.

According to Prabhat Ranjan Mahapatra of Odisha State Disaster Management Agency (OSDMA) the next level in disaster management is to factor in new challenges and prepare for a larger magnitude of a disaster, especially in the context of health.

“For example, we get small quakes in Odisha but not major ones, but if a major one strikes then are we ready? In cyclone Titli in 2018, 50 people died of landslides alone in hilly tribal-dominated areas in the interior of the state. Which means we have to consider health system readiness during disasters in other areas and those that have more vulnerable groups,” said Mahapatra.

“Do we have that level of preparedness?” asked Mahapatra at a consultation workshop on ‘Health system readiness for extreme climate events: Lessons learnt from Cyclone Fani and Way Forward’ organised by Population Council in collaboration with CARE India.

Population researcher Bidhubhushan Mahapatra batted for more research that identifies the vulnerabilities existing in the health system. Additionally, “preparing the system as per community need and the likelihood of disasters,” is also important, Mahapatra of Population Council told Mongabay-India.

One area is the link between poverty and healthcare access. Economic losses from disasters push people into poverty, scuppering their access to medication said Binapani Misra of Odisha-based NGO Society for Women Action Development that works for disaster resilience among women.

“The 1999 supercyclone killed thousands but Fani has taken us back economically by 15 years,” remarked Misra.

“Because of unprecedented damage to livestock, cash crop, particularly coconut and property, Fani affected people were thrown into financial turmoil. This hampered their access to medications in various pockets and many of those affected went to consult quacks because of the absence of healthcare workers in certain areas,” Misra told Mongabay-India.

Skin diseases, poor nutrition and the impact of heatwaves connected with disasters

Misra added that skin diseases became a concern during the cyclone. “This time, after Fani, we didn’t see too many water-borne infections because there were no floods. But we noted skin diseases and fevers emerge after Fani. And many people are still without proper treatment,” Misra said, adding that attention should be given to healthcare workers who often face health risks during disasters.

Food and nutrition security, particularly among children, has also emerged as a major worry. Women in a migrant fishing community in a slum in Puri, where Fani made landfall, told this visiting Mongabay-India correspondent how they struggled to provide cooked food to their children in the cyclone’s aftermath.

“It was tough to see our children go hungry for days following the storm. It took time for us to get cooked food through relief efforts,” recalled 35-year-old Koda Uma, whose family of seven was scattered across cyclone shelters in the ensuing evacuation in Puri’s Penthakatha.

Floods and drought have also been noted to have had an impact on nutrition and thus health, specifically among children in Odisha.

Floods that submerged crops and lead to subsequent crop failure, scuttled children’s growth and development in several pockets in the state said a review paper by ICMR- Regional Medical Research Centre, Bhubaneswar, and UNICEF, National Health Mission, Bhubaneswar researchers. Instances of severely weakened children were three times higher in areas affected by floods in comparison to non-flooded areas in Jagatsinghpur district that was affected by floods in 2008, dubbed as the worst in 50 years.

In Odisha’s Balangir district, a chronically drought-prone area, 2010 drought caused a fall in calorie intake among children in two villages, which lead to health problems as well as death from malnutrition among children. Health problems relating to water were common, in addition to weakness, pregnancy-related issues and pre-mature deaths in Balangir and Kendrapara districts after a drought episode said a 2012 study.

Odisha has previously reeled under the impact of heatwaves which returned this year after Fani. In 1998, Odisha was thrust into the limelight when a severe heatwave claimed over 2000 lives. Heatwaves affect Odisha districts, particularly hitting the health and well-being of a large chunk of people employed in the unorganised sector such as labourers, vendors, rickshaw pullers. Long-term heat exposure forces people to stay indoors and lose out on income-generating opportunities. In addition to the unorganised sector, the elderly, children and people living in urban slums, including migrant communities, are among those vulnerable to heatwaves, according to the review paper.

After-effects of Fani continue months later with disabled and mentally ill at a disadvantage

It’s November and R. Pati, a rental car driver in Puri, is still waiting for a proper place to sleep months after Fani flattened his one-room concrete house in summer.

Showing off a plastic bag with clothes and essentials stuffed into it, Pati said this is all he has. “I live in a makeshift shelter and initially I had to nurse a forearm injury from debris falling off during Fani. I am thankful that the injury healed with basic treatment otherwise I could have been disabled. Life is good,” Pati narrated to Mongabay-India with a sarcastic laugh.

Pati’s remarks aren’t off the cuff. Disasters have an impact on disability by disproportionately affecting the disabled and creating a new generation of people with disability, according to the World Health Organisation. The National Disaster Management Authority, which has drafted guidelines on disability and disasters, acknowledges that during the last decade disasters and increasingly climate change have had a significant impact on about 2.68 crores (26.8 million) people with disabilities in India.

In December 2019, the OSDMA announced that it has set up a dedicated cell for issues on disability during a disaster.

Fani’s intensity also revealed the burden of disasters on mental health. A growing body of research has pointed to linkages between mental health and environmental stressors exacerbated by climate change, including tropical cyclones.

Psychosocial support and mental health services are embedded in India’s disaster management framework. Looking forward, Odisha has started building the capacity of local community workers such as accredited social health activist (ASHA) and other health workers to conduct interventions such as active listening, counselling and identifying symptoms of mental stress in the wake of a disaster.

“In the last several cyclones and other disasters, we have been able to save a lot of lives. But are the people satisfied and have they had a convenient stay in cyclone shelters? We now want to focus on sheltering with dignity, especially for women, and minimising inconvenience,” said Prabhat Ranjan Mahapatra.

When Mongabay-India visited a section of cyclone shelters in Puri district, a month after Fani’s occurrence, open defecation, among women, was observed to be quite rampant. Women told this correspondent that they found it uncomfortable to use toilets with men around and the lack of sanitary napkins was also problematic.

Shridhar Kadam of IIPH-Bhubaneswar said apart from policy measures, involving ASHA workers and women-led self-help groups in decision making will enable better communication and access to health services in relevant areas during disasters. One-size fits all solution won’t work.

“For example, chlorine tablets are being distributed by many self-help groups. If they are involved in decision making, then planning and mapping gaps and deciding course of action can be customised in accordance with what the community needs,” Kadam added.

Banner image: A mother and child in a relief camp. Photo by Sahana Ghosh/Mongabay

This story was first published on Mongabay India.