Community Needs Assessment and Morbidity Surveillance Following an Earthquake -- Turkey, August 1999

On August 17, 1999, at 3:01 a.m., an earthquake registering 7.4 on the Richter scale, with an epicenter on the northern strand of the North Anatolian fault near the town of Gölcük, struck western Turkey. The earthquake resulted in an estimated 17,000 deaths and 10,000 missing persons. An additional 24,000 persons were injured, and approximately 600,000 were left homeless. Numerous aftershocks occurred during the following month, causing further damage and loss. To provide an objective postdisaster measure of needs to decision makers in the affected area, at the request of Turkey's Marmara University Department of Public Health, CDC conducted a community needs assessment in one camp and a study of clinic visits in two camps 2 and 6 weeks after the earthquake. This report summarizes the results of the assessment and studies, which indicate that housing and winter clothing were the primary needs in the camp and upper respiratory ailments, depression, and musculoskeletal pain were the predominant illnesses.

CDC conducted the needs assessment in the Bahcecik camp that local authorities established 1 week after the earthquake in the Gölcük region, possibly the area most affected by the disaster. In collaboration with Marmara University Department of Public Health, local health authorities initiated health-care services for the camp, which had 248 tents. On October 1 and 2, CDC conducted a household survey using a systematic, random sample of a targeted 155 households. A household was defined as a unit of persons residing in one tent. One adult was interviewed from each selected household using a standardized questionnaire that focused on demographics, illnesses, injuries, sanitation, shelter, and medical needs.

Morbidity surveillance data were characterized during the subacute, post-earthquake phase at the Bahcecik camp clinic and the Izmir camp clinic in the Gölcük area. CDC reviewed logbook entries for two 8-day periods, from August 30 (the first day for which clinic records were available at both sites) through September 6 and from September 25 through October 2. For the first 8-day period, 468 and 534 logbook entries at the Bahcecik and Izmir camp clinics, respectively, were reviewed; for the second 8-day period, 411 and 669 logbook entries, respectively, were reviewed.

In Bahcecik, 154 households were visited, and 86 (56%) interviews were completed. The survey represented 339 persons (median household size: four persons). Of the 86 households, seven (8%) had a child aged less than or equal to 2 years, nine (10%) had a household member aged greater than or equal to 65 years, and three households (4%) reported a pregnant female. Fifty-four (63%) reported that their homes were damaged and uninhabitable, and 22 (26%) reported their homes were destroyed completely.

The Bahcecik clinic provided medical care for persons in 85 (99%) of the surveyed households. Of the 86 households, one (1%) reported an earthquake-related death.* Members of 20 (23%) households sustained injuries, and lacerations accounted for 90% of the injuries. Sixty-nine households (80%) reported having at least one ill household member since the earthquake, representing 128 ill persons. Approximately 32 (25%) persons reported depression; 14 (44%) of those sought medical treatment. Twenty-four (19%) persons reported respiratory illness; 23 (96%) of those requested medical treatment. Twenty (17%) noted chronic diseases, specifically kidney problems, hypertension, and heart disease; 16 (80%) of those sought medical treatment. Thirteen (10%) experienced gastrointestinal illness; 11 (86%) of those sought medical treatment.

The availability of food, water, and sanitation was well maintained after the earthquake. Respondents from 75 (87%) of the 86 households reported that food was available and was provided mainly by the relief workers in the camp. Eighty-one (94%) households reported piped water as the major source of drinking water. Eighty-three (97%) households had access to showers. Most households (83 [97%]) reported using field latrines connected to septic tanks for human waste disposal, and 45 (52%) households reported the latrines as "clean" or "somewhat clean." In 77 (90%) households, members had access to transportation, and 83 (97%) households had garbage disposal by municipal collection. Electricity was not available for 79 (92%) households.

Logbook entries at Bahcecik camp clinic and Izmir camp clinic from August 30 through September 6 and September 25 through October 2 indicated that most visits were for illnesses rather than injuries (Table 1). The primary illnesses reported during the 8-day periods in both camps were upper respiratory tract infection, followed by musculoskeletal pain. All other illnesses, including diarrhea, represented no more than 10% of the total visits (Tables 2 and 3).

Reported by: J Jennings, PhD, Conscience International, Inc., Atlanta, Georgia. H Harmanci, MD, T Erbaydar, MD, Marmara Univ Dept of Public Health; S Erbaydar, MD, N Yolsal, MD, Istanbul Medical Faculty, Dept of Public Health, Istanbul, Turkey. Environmental Hazards Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Applied Public Health Training, Epidemiology Program Office; and an EIS Officer, CDC.

Editorial Note:

An earthquake of great magnitude is one of the most devastating events in nature. In Turkey, infrastructure damage and losses were an estimated $6.5 billion. In the Bahcecik camp, where 88% of the camp's population is homeless, the primary need is housing. Most inhabitants will remain in tents until they receive prefabricated houses. In addition, the low frequency of gastrointestinal diseases suggests that sanitary conditions at the camp are well maintained. Although 73 (85%) households indicated access to a medication source and direct observation showed a well-stocked medication supply area, the most common medications needed for diabetes, hypertension, depression, and analgesics and vitamins were not available according to those interviewed.

Following the assessment and studies, results were reported to the local health authorities of Turkey and the nongovernment organization. Recommendations included providing shelter, heat, and clothing suitable for winter conditions; providing mental health-care services, social activities, and community jobs to address community stress; continuing the level of medical care; and encouraging reporting of morbidity data from local camp clinics to regional health offices.

Rapid needs assessment of an affected population is an important initial step of response in a disaster and can minimize inappropriateness of relief in terms of delays and content (1). In addition, information from emergency medical surveillance may control the rumors of epidemics and help local health authorities of Turkey focus on allocating resources to address identified needs to reduce overcrowding and provide counseling.

Reference

1. Guha-Sapir D. Rapid assessment of health needs in mass emergencies: review of current concepts and method. World Health Stat Q 1991;44:171-81.

* This low percentage probably reflects that Turkish families generally live together in one household and that entire families either died or survived. It does not reflect friends, co-workers, and possible extended family members who were killed.

TABLE 1. Number and percentage of illnesses and injuries reported at Bahcecik camp and Izmir camp clinics -- Turkey, 1999

TABLE 2. Number and percentage of illnesses reported at Bahcecik clinic 2 and 6 weeks after earthquake, by diagnosis and week -- Turkey, 1999

TABLE 3. Number and percentage of illnesses reported at Izmir clinic 2 and 6 weeks after earthquake, by diagnosis and week -- Turkey, 1999

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