|LETTERS TO EDITOR
|Year : 2019 | Volume
| Issue : 4 | Page : 290-293
Flood relief interventions in Kerala: A factsheet and critical analysis based on experiences and observations
Jose Jom Thomas, B Prakash, Praveen Kulkarni, M R Narayana Murthy
Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
|Date of Submission||13-Dec-2018|
|Date of Acceptance||28-Aug-2019|
|Date of Web Publication||15-Oct-2019|
Dr. Jose Jom Thomas
Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Bannimantap, Mysore - 575 015, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thomas JJ, Prakash B, Kulkarni P, Murthy M R. Flood relief interventions in Kerala: A factsheet and critical analysis based on experiences and observations. Int J Health Allied Sci 2019;8:290-3
|How to cite this URL:|
Thomas JJ, Prakash B, Kulkarni P, Murthy M R. Flood relief interventions in Kerala: A factsheet and critical analysis based on experiences and observations. Int J Health Allied Sci [serial online] 2019 [cited 2019 Nov 22];8:290-3. Available from: http://www.ijhas.in/text.asp?2019/8/4/290/269241
The world is witnessing a significant change in its climate mainly due to the anthropogenic forcing in various ways. The increasing incidence of natural disasters since 1960s traces its roots to the global climate change. India, due to its peculiar geography and climatic conditions, is vulnerable to many major and minor natural disasters. The latest in the list is the flash floods occurred in Kerala state in August 2018.
A 23.34% extra rainfall was received in Kerala from June 1 to September 30, 2018. The 164% additional rainfall in August alone, led to the most severe flood in the state in 100 years. The flood claimed 483 lives with many residents missing. More than 14.5 lakh people were forced to move to flood relief camps across the state. The economic loss was calculated to be more than the annual outlay of the state. A note on flood relief interventions based on my experiences and observations as a volunteer in relief activities from August 15th–19th in Wayanad district and October 8th–15th in Idukki district of Kerala is shared here.
| Fact Sheet|| |
The relief activities in Wayanad district were coordinated by the district administration under the Collector and the revenue department. Excellent inter-sectorial coordination of different departments such as the Police, NDRF, Indian Army, Health and Family Welfare, Education, and Tourism was observed, and a huge number of volunteers from various sectors participated in the flood relief. The district civil station was serving as a store for flood relief materials such as raw and cooked food items, packaged drinking water, sanitary items, clothes, blankets, and beds received from various neighboring states and districts. Dedicated vehicles with relief materials were sent to each Panchayats, and they were distributed to camps and tribal colonies based on needs, reported by camp administrators and village officers. Daily evaluation meetings were conducted in civil station headed by district collector in the presence of political leaders, various department officers, volunteers, religious leaders, and representatives from the affected areas to assess further needs and implement actions.
At the village level, the revenue and police departments were actively involved in search, rescue, and rehabilitation of affected families to camps. The camps were located at local schools and various religious institutions and nonreligious institutions such as community halls, auditoriums, and pastoral centers. The head teacher was mainly administrating camps in schools and Anganwadi workers, ASHA workers and other health professionals represented the government in other camps. Ward members/municipality counselors, political leaders, volunteers, nongovernmental organizations (NGOs), and religious institutions also worked sincerely in coordinating the activities.
People whose houses were damaged or were under threat of damage by flood or landslides in the coming days were requested to move to the relief camps. However, there was a resistance from many residents due to various reasons such as unsatisfactory facilities provided in camps, unwillingness to leave their belongings, emotional attachment to the house and lack of awareness about the importance of moving to safer places. The facilities provided by the government failed to meet the regulations by the National Disaster Management Authority of India (NDMA). Among the camps observed, only 29% were able to provide 3.5 m2 area per head to the inmates [Figure 1]. The NDMA instruct one toilet per 20 disaster victims and 15 L potable water and 2100 kcal food for each adult resident in relief camps. Nearly 80% of the camps visited in Wayanad district were able to provide sufficient sanitary toilets to their inmates. While the district administration was not able to meet these requirements, voluntary organizations and local residents contributed to meet the requirements.
|Figure 1: Percentage of camps with square meter per person area provided (Approximate)|
Click here to view
The tribal communities in Wayanad faced several problems during the monsoon season. Most of the tribal people depend on daily wages, and there was a significant shortage in work leading to severe poverty in tribal settlements. Worsening the problems, the flash floods led to the isolation of many tribal colonies, depriving the residents of food and medical care. The district administration and voluntary doctors provided the basic needs in tribal colonies.
The health sector in both Wayanad and Idukki districts was under severe stress. The frontline health works such as ASHAs and AWWs were actively involved and provided full-time service in relief activities. Drugs and sanitary items reaching civil station were handed over to the health department, and the same were distributed to camps by the health workers. Medical doctors who came forward to volunteer in flood relief were allotted to Primary Health Centres (PHCs) under stress, in addition to the medical officers. An emergency helpline and toll-free number was provided by the district hospital to contact in case of any health emergencies and free spot service by doctors and other health professionals was made available. A team consisting of medical officer, pharmacist, staff nurse, and driver visited all camps daily and provided medical care. A break in the supply chain of medicines due to the isolation of many areas by the flood led to the rise of many health issues. The common health issues among camp residents were fungal infections such as Tinea Pedis and acute respiratory infections. A district-wide cleanup program was organized on August 30. Doxycycline, free of cost, was provided to flood-affected individuals and volunteers who participated in the cleanup program to prevent the outbreak of leptospirosis. However, there was a shortage of the drug in the initial days. No immunizations were provided to volunteers or victims.
Many patients who approached the medical camps showed symptoms of somatization, anxiety, and depression. Hence, a screening for depression using PHQ9 questionnaire was done, and the analysis of the data showed a significantly high prevalence of depression (48%) among the flood-affected individuals, 1 month after the incident. About 28.1% were mildly depressed and 12.7% were moderately depressed. The prevalence of moderately severe depression was 5.56% while severe depression was seen in 1.63% of patients screened.
Even though the government announced a compensation of Rs. 10,000 to all the families moving to the relief camps, only a few families received the amount on time. Four lakhs rupees was announced to those who lost their houses completely and 2 lakhs was announced to those who lost their land. However, the beneficiaries commented that the amount was insufficient and was not provided to them even after 2 months of the disaster. Four lakhs rupees was announced to the families who lost their member's life in the disaster.
| What Went Well?|| |
The timely and immediate action of district administration played a major role in reducing the impact of the disaster. Effective and good inter-sectorial coordination involving different departments, NGOs, religious institutions, and volunteers made the relief works practical. The effective use of social media and workforce in giving alerts, identifying vulnerable communities, search and rescue, made the flood relief activities in Kerala unique. The huge number of volunteers and the immense response and aid from neighboring states made the relief activities much more efficient. Village committees were made to manage the local needs, and damage surveys were done involving teachers and revenue officers within the localities. The response from Health and Family Welfare Department was impressive and timely actions played a major role in controlling postdisaster outbreaks of epidemics.
| Where to Improve?|| |
The major drawback in the state was the lack of preparedness. The weather forecasting system was failed in communicating the alerts to the people effectively. According to the residents, alarming and evacuating before opening the dams were not sufficient. The frontline health workers and other department employees such as teachers were unaware of the disaster management and NDMA regulations. The poor town planning increased the impact of floods to a greater extent and led to the isolation of many places. Illegal constructions and exploitation of lands led to an increase in landslides and other flood effects. The entire flood relief framework lacked the element of decentralization which led to an unequitable distribution of materials to different Panchayats and relief camps. The camps and the facilities provided to victims did not adhere to the NDMA regulations. The health and medicine reserves failed to meet the emergency situation in many places. The mental health aspect of victims was neglected. No vaccinations were provided to volunteers, and prophylactic medicines faced a shortage in the initial days. The insufficient funds to handle the situation lead to a delay in compensations and reconstruction. A major gap exists between projected and provided compensations to the victims.
| How to Improve?|| |
The preparedness for natural disasters should be improved to face further similar situations in the future. All government employees, doctors, paramedical workers, teachers, political leaders, and students should be trained for basic disaster management. Systematic training should be given through scout and guides, junior Red Cross, NCC, and NSS in educational institutions. The public should be educated, and mock drills should be conducted. Residents of all areas should receive information regarding possible natural disasters in their area, and awareness should be created to deal such emergencies. The environment policies should be reexamined. Strict legal actions should be taken to stop exploitation of the environment and prevent unscientific constructions. The building designs should be modified anticipating similar events in the future. Holland model floating houses and elevated houses can be built in low lying areas. The dam break levels should be reexamined and proper alerts and warning should be given to residents downstream. The weather forecasting and public alarming systems should be improved. Permanent village level committees can be created, and a decentralized disaster management system should be designed to face emergencies in future. The regulations should be properly followed in case of emergencies. More community participation should be ensured in the initial days itself. A plan of action for each Panchayat should be designed. Local disaster relief groups should be formed and they should be trained to fill the gap in search and rescue before external agencies such as police, army, and NDMA arrive. More medicine reserve should be kept in accessible locations in different parts of the districts to avoid breaks in medicine supply chains. More psychiatric interventions such as counseling and pharmacotherapy should be made available for disaster victims in the future considering the high incidence of depression. The compensations should be provided on time, as early as possible to help the victims in rehabilitation.
| Challenges to Face|| |
The high population density increases the vulnerability to disasters. Lack of infrastructure for relief camps, especially in rural areas, remains a big challenge. The peculiar geography of Kerala state possess a threat of landslides. The false alarms, news, and claims through social media significantly interfere with disaster management. Lack of proper documents in many houses in the disaster-affected areas will lead to many legal complications while applying for compensations.
The incidence and severity of natural disasters are increasing every year. Anticipation of natural disasters by communities and governments is very important. The main aspect where we are lagging behind in disaster management is the preparedness. All health professionals, including frontline health workers, local leaders, teachers, and the public, should anticipate and prepare to respond to disasters quickly and effectively.
- Flood-affected residents of Kerala
- District Administration of Wayanad
- Kottayam Social Service Society
- Greenvalley Development Society
- Catholic Health Association of India
- Sister Doctors Forum of India
- Flood relief volunteers in Kerala
- Department of Community Medicine, JSS Medical College.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Scheuren JM, De Waroux O, Below R, Guha-Sapir D, Ponserre S. Annual Disaster Statistical Review: The Numbers and Trends; 2007.
Mohandas E. Roadmap to Indian psychiatry. Indian J Psychiatry 2009;51:173-9.
] [Full text]
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13.