Increased health vulnerabilities of flood victims amid Covid-19

Floods are the act of the God, but flood losses are largely acts of man.
- Gilbert F White

Globally, people have been encountering natural, agricultural and health disasters such as cyclones, floods, earthquakes, landslides, forest fires, locust attacks and Covid-19 pandemic, from the beginning of 2020. The current year has created innumerable appalling memories for people of the world due to the Covid-19 pandemic. For people in Bangladesh, in particular, the memories of this year are even grimmer. Amid the proliferating cases of Covid-19 and disruption of social, physical, psychological and economic lives every day, the natural calamities have had further cataclysmic repercussions.

According to John Hopkins University, until now, 2,42,102 infections and 3,184 deaths have been recorded in Bangladesh. However, besides the people directly affected, the number of people affected socially, economically and psychologically is incalculable. Cyclone "Amphan" in mid-May and the current monsoon floods have resulted in losses of human lives, infrastructural collapse, destruction of food and financial resources and, most importantly, made health vulnerabilities more catastrophic alongside the pre-existing health hazards due to the pandemic.

According to Prof AKM Saiful Islam of BUET's Institute of Water and Flood Management, around 37 percent of the country's land mass has been flooded. A substantial portion of over half a million people in 159 upazilas under 33 districts have been affected by the concurrent flooding, according to the latest report of the National Disaster Response Coordination Centre (NDRCC).

Consequently, food shortages and a lack of clean water, shelter, sanitation and hygiene has caused widespread devastation among the flood-affected communities, while the Covid-19 pandemic has posed further challenges towards ensuring a safe and healthy environment for the victim communities. Such circumstances have produced dilemmas in building resilience, mitigation strategies, providing healthcare to flood victims and simultaneously suppressing the rate of Covid-19 infections from proceeding further.

The World Health Organisation (WHO) has outlined in its 'Flood and Health: Factsheets' that two-thirds of flood-related deaths worldwide are from drowning and one third are from physical trauma, heart attacks, electrocution, carbon monoxide poisoning or fire. These health effects occur either directly through contact with flood, water or indirectly through damaging infrastructure, ecosystems, food and water supplies or social support systems. Around 5 million people and 11,14,508 waterlogged families have become vulnerable to the health hazards of the flood. Subsequently, the population has also become susceptible to Covid-19 infections leading to further aggravations. Owing to the flood, 63,409 people and 78,046 domestic animals have been evacuated to 1,533 shelters throughout the country.

Inundations at shelters coupled with inadequate social distancing, sanitation and hygiene pose inevitable risks of health hazards and coronavirus infections. So far, 135 people have died because of the current flooding, according to the Directorate General of Health Services (DGHS). Physical access to primary healthcare services has been obstructed due to restricted mobility and disrupted communication systems. The most vulnerable groups are women and children who face additional threats. Women are lacking access to maternal healthcare services, sexual and reproductive health, privacy and face increased mortality and gender-based violence. Due to shortage of food, children are facing insufficient proper nutrition whose outcomes are diseases due to nutritional deficiency.

Furthermore, an unavailability of safe drinking water and hygiene practices aids the increase of waterborne, vector-borne and rodent-borne diseases and exacerbates the spread of coronavirus infections. The unavailability of these resources stands as an impediment to curbing the spread of infectious diseases like the coronavirus. A study published in the Journal of Environmental and Public Health conducted an extensive literature review published between 2000 and 2017 and suggested that outbreaks of infectious diseases have been associated with flooding. Although no pandemic has existed concomitantly with previous floods, there is no doubt that the existing   Covid-19 pandemic will become disastrous if the health safety of the flood victims is compromised. Bangladesh is still struggling to bring down the magnitude of the pandemic and hopes of progression become dim if these factors are left unaddressed.

With one-third of the country submerged and a significant amount of the population infected, prioritising one disaster over another would only aggravate the other. It is only through simultaneous endeavours and systematic planning that these dual challenges can be countered. The United Nations Office of Disaster Risk Reduction (UNDRR) issued a brief on "Combating the Dual Challenges of Covid-19 and Climate-Related Disasters" and recommended multi-hazard risk preparedness, proactive action to reduce vulnerability, protection of frontline workers, and local action as important deliverables. Countries must have assiduity towards the mitigation strategies which should be developed in line with the Covid-19 eradication plans.

To counter the dual challenges, first and foremost, disaster response plans should be revised in accordance with Covid-19 mitigation strategies. It should be mandatory to identify the districts where there is a potential convergence of the two disasters and to judiciously allocate available resources. The Ministry of Disaster Management and Relief (MoDMR) should also prioritise health hazards of coronavirus in these situations of disasters. Mitigation strategies to cease the infections through tests and contact tracing should be considered. Also, accommodating the affected population in small groups and avoiding contact will most likely help in the dual challenges. The next National Plan for Disaster Management should include health risks in their comprehensive disaster risk management strategy, programmes and plans as the pandemic does not seem likely to end anytime soon.

Secondly, a considerable amount of manpower should be created by recruiting volunteers, civil society and healthcare workers. The formation of 967 medical teams by the disaster and relief ministry is a step in the right direction and certainly deserves applause. However, only 399 teams are currently active. Provisions must be made to dispatch the rest of the teams as early as possible. Furthermore, the importance of local authorities to manage the crisis efficiently and responsibly is foreseeable.  

Thirdly, and most importantly, extensive relief distribution is compulsory to secure the affected communities from health hazards, especially women and children. Unfortunately, flood victims of multiple areas have also complained about inadequate allocation of relief. Such negligence only attaches more vulnerability to the already vulnerable communities. Moreover, face masks, disinfectants and clean water should also be dispensed and the affected communities should be made knowledgeable in order to resist contamination of infectious diseases and encourage safe and hygienic practices.

Currently, identifying and insulating the vulnerable communities should be the top priority in the flood-stricken country. However, with the widespread Covid-19 pandemic, the resilience and mitigation strategies must be modified bearing in mind the simultaneous regulation of both the situation and to obstruct it from becoming anymore cataclysmic.

Therefore, with the adaptation of a detailed response plan and management system, we can be optimistic about addressing the monsoon floods and the Covid-19 pandemic together.