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Opinion: Water Contamination and Public Health Impacts Post-Earthquake

Nepal after the earthquake
Disasters are unpredictable; they can strike anytime, anywhere.  Natural disasters do not discriminate between socioeconomic, political or national boundaries.  When they strike, however, human lives and properties are lost or greatly impacted.  Survivors risk their lives from a host of consequences including contaminated drinking water, even more so in the developing countries.
Nepal, a small Himalayan country sandwiched between the two giants—India and China, is rich in freshwater resources, with more than 6000 rivers, 2,300 lakes and thousands of springs and tributaries.  However, there has been a longstanding problem regarding access to safe drinking water, largely due to surface and groundwater contamination from excessive use of chemical fertilizers coupled with surface runoff, hazardous wastes disposal, septic failures, open defecation and waste disposal alongside the rivers.  Lack of adequate policy measures and regulations aimed at surface and groundwater protection promoted these human activities leading to water pollution in Nepal.
April 25, 2015 was one of the darkest days in the history of modern Nepal.  An earthquake of magnitude 7.9, with an epicenter at Barpak in Gorkha district, rattled Nepal wiping out many cities and villages, including multiple UNESCO World Heritage Sites, and claimed about 9000 lives, injured twice as many, and more than a million displaced with no shelters to live in, food to eat, and water to drink.    
Contamination of water sources in the aftermath of earthquakes is commonplace.  Decaying bodies of the deceased humans and animals, their mass cremation, chemical spills, septic failure, and cross-contamination of the sewer lines with the drinking water distribution systems could impact surface and groundwater quality, thus increasing the risk of water-borne illnesses post-earthquake.
Compared to flood disaster that often leaves stagnant water contaminated with pathogens in and around the residential areas, generally post-earthquake environment tends to be more hygienic, however.  In contrary, deterioration of environment tends to continue much longer after earthquake and the water infrastructures which may have received damage can result in water and food borne infections due to pathogen infiltration into the water reservoirs and/or distribution systems.
Acute respiratory infections (ARIs), such as influenza and pneumonia, typically affect earthquake victims.  The major risk factors for ARIs after earthquake are overcrowding condition and insufficient nutrient intake commonly associated with infections from water-borne diseases.
First responders are a vital portion of the global response to natural disasters.  They are at risk from exposures to air-borne contaminants in the dust, from the chemicals spilled in debris, and potential physical injuries that may incur during rescue efforts and during the demolition of the weakened buildings and other physical structures in the aftermath of quake. General cloth masks, as seen used by some in the aftermath of Nepal’s quake, are only protective against less hazardous dust particles that are larger in size, but typically do not confer protection against smaller particulates (e.g., PM10, PM2.5) which are considered the most harmful ones. 
If the responders from other countries are asymptomatic carriers of gastrointestinal or other pathogens, they could expose local population, now at greater risk due to temporary housing or other complicating factors, to a possibly foreign pathogen, potentially leading to increased disease spread and health effects.  Alternatively, the responders are exposed to a foreign environment, with pathogens that they possibly were not exposed to beforehand.  This can be controlled through pre-deployment vaccinations.  Given the uncertainty of vaccine effectiveness in groups, there is still a risk of infection or illness.  This is further compounded for carriers of disease such as Ebola for which no vaccines are available.  Therefore, initial medical screening of the foreign volunteers ought to be in place before they enter the foreign land for relief aid.  Nevertheless, these concerns are mitigated by the lives saved and populations aided through their actions. 
In Nepal, with monsoon kicking in soon, issues related to water quality and sanitation will become even more critical for those displaced and living in temporary makeshift shelters.  Timely management of disaster debris, including of human waste from the latrines which are likely to overflow as the soil saturates with the monsoon rain, is imperative to avoid any fecal-oral transmission of communicable diseases such as diarrhea, cholera, and jaundice.  In this situation, infants, children, elderly and those sensitive immuno-suppressed sub-populations should be the major focus of the relief efforts as they are at higher risks of contracting the disease and can become chronically ill.  Potential risks from poisonous insects, snakes and other wild animals can also be high until those displaced get a permanent house to live which they can call a home.
Following the April 25th quake, growing unaccountability of the government and of the political leaderships has only widened the people’s distrust toward them more than ever.  Amidst the frustrations, youth workforce from near and far has filled the void to support rescue and relief efforts alongside the national and international police and army personnel.  Kudos to international support which has remained overwhelming!  The situation seems perilous on the ground, nonetheless.  At this time, a new dialogue of forming a visionary government – one that has a clear plan and rigorous programs to accomplish the plan; one that is proactive; that takes full responsibility of acting as the support apparatus for those who need at the time of disaster and also prepares them well to cope up in any future disasters; and that coordinates international aid delivery effectively and in timely fashion – ought to begin and in this context some discussions have been taking place.  This is encouraging for the Himalayan country and her fellow citizens, perhaps a step toward the “New Nepal” that every Nepalese has been dreaming of after 2006 when Maoist atrocity ended. 
The time cannot be this high for all the Nepalese― young and old, and those at home and abroad ― to join hand in hand to turn this tragedy into triumph.  Rebuilding seems daunting seeing the utter devastation but with strong commitments from all sectors, it can be achieved.
Lok R. Pokhrel, PhD, MS, MSc, is an Assistant Professor of Environmental Health at Temple University’s College of Public Health, where he conducts research on water quality, nanotechnology, environmental toxicology and risk assessment.
Mark H. Weir, EIT, PhD, is an Assistant Professor of Environmental Health at Temple University’s College of Public Health, where he conducts research on water quality and treatments, environmental toxicology and microbial risk assessment.
Toru Watanabe, PhD, is an Associate Professor of Food, Life and Environmental Sciences at Yamagata University, Japan, where he conducts research on water supply and sanitation in tropical regions, and disease risks associated with natural disasters.]
Posted:  June 1, 2015