Flood Related Illnesses

by Dr. Behrouz Hashim

Pakistan is once again going through another spell of very heavy rains and floods. It was just last year that we went through a devastating catastrophe.

What did we learn from last year?

Why are we facing more problems this year?

This article will help you deal with the ailments caused by rain and floods. Hopefully you too will take preventive measures and help the flood victims.


All floods are not alike. Some floods develop slowly, sometimes over a period of days. But flash floods can develop quickly, sometimes in just a few minutes, with-out any visible signs of rain. Flash floods often have a dangerous wall of roaring water that carries rocks, mud and other debris, and can sweep away almost anything in its path. Overland flooding occurs outside a defined river or stream, such as when a levee is breached, and can still can be destructive. Flooding can also occur when a dam breaks, producing effects similar to flash floods.

Be aware of flood hazards no matter where you live, but especially if you live in a low-lying area, near water or downstream from a dam. Even very small streams, gullies, creeks, culverts, dry streambeds, or low-lying grounds that appear harmless in dry weather can flood.

Flooding is associated with an increased risk of infection, however this risk is low unless there is significant population displacement and/or water sources are compromised.




Gasteroenteritis can cause massive diarrhoea that leads to dehydration and death.

This is more common in young infants and the very old.

Flood can also potentially increase the transmission of the following diseases:


→ Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis

A and E.

→ Vector-borne diseases, mainly transmitted by mosquitoes, such as malaria,

dengue and dengue haemorrhagic fever.

→ Pneumonia, influenza And meningitis, are also big killers.

→ Parasites and worm infections.

→ Various skin infections, eczema, and rash.

→ Ant and insect bites.

→ Snake bites

→ Dog bites


Other health risks


→ Include drowning, injuries or trauma.

→ Back injuries because of lifting children, belongings, sweeping floors and

clearing water from indoors and out doors, carrying sand bags, pushing cars that

got stuck on the roads or in ditches.

→ Motorcycle and cycle accidents.

→ Electric shocks due to wet feet and hands, in the house and on the streets.

→ Roof and wall collapse.

→ Falling into gutters and ditches.

→ Slips and falls causing fractures and head injuries.

→ Rat bites and other animal bites.

→ Tetanus is common after injury from flooding, and mass tetanus vaccination

programs are required. However, tetanus boosters may be indicated for previously vaccinated people who sustain open wounds or for other injured people depending on their tetanus immunization history.

→ Hypothermia may also be a problem, particularly in children, if trapped in

floodwaters for lengthy periods. There may also be an increased risk of       respiratory tract infections due to exposure (loss of shelter, exposure to flood waters and rain).

→ Power cuts related to floods may disrupt water treatment and supply plants

thereby increasing the risk of water-borne diseases as described above but may

also effect proper functioning of health facilities, including cold chain.







Communicable disease risks from flooding can be greatly reduced if the following recommendations are followed.




Chlorination of water


Ensuring uninterrupted provision of safe drinking water is the most important preventive measure to be implemented following flooding, in order to reduce the risk of outbreaks of water-borne diseases.


→ Free chlorine is the most widely and easily used, and the most affordable of the

drinking water disinfectants. It is also highly effective against nearly all

waterborne germs . At doses of a few mg/liter and contact times of about 30

minutes, free chlorine generally inactivates >99.99% of enteric bacteria and


→ For point-of-use or household water treatment, the most practical forms of free

chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and

bleaching powder ( chloride of lime; a mixture of calcium hydroxide, calcium

chloride and calcium hypochlorite).

→ The amount of chlorine needed depends mainly on the concentration of organic

matter in the water and has to be determined for each situation. After 30

minutes, the residual concentration of active chlorine in the water should be

between 0.2-0.5 mg/1, which can be determined using a special test kit.

→ Water purification tablets.




→ Hepatitis A

→ Tetanus

→ Pneumonia

→ Meningitis

→ Polio

→ Typhoid

→ Flu

→ Rota virus (Gastroenteritis)





→ Insecticides: flooding does not necessarily lead to an immediate major increase

in mosquito numbers, and there may still be time to implement preventive

measures such as indoor residual spraying. This will also have an effect on other

mosquito-borne diseases.

→ Early detection: It is important to track weekly case numbers and provide

laboratory-based diagnosis (perhaps only for a percentage of fever cases to

track the slide/test positivity rate), to pick up the early stages of a malaria


→ Mosquito nets and repellants.

→ Free medical care: artemisinin-based combination therapy should be provided

when a falciparum malaria epidemic is confirmed and an active search for fever

cases may be necessary to reduce mortality in remote areas with reduced access

to health care services.




There is a massive shortage of food in floods. These are the points to keep        in mind:


→ Make sure the food that they get is not easily perishable.

→ Much of the food available may be contaminated.

→ There may be no containers or storage items to preserve the food.

→ There may be no dry wood, matches or kerosene or gas cylinder in flooded

areas. So how would you cook or boil water?



→ Burial is preferable in mass causalities and where identification of victims is not


→ The mass management of human remains is often based on the false belief that

they represent an epidemic hazard if not buried or burned immediately. Bodies

should not be disposed of unceremoniously in mass graves and this does not

constitute a public health measure, infact it violates important social norms and

can waste scarce resources.

→ Families should have the opportunity to conduct culturally appropriate funerals

and burials according to social custom.


→ Where customs vary, separate areas should be available for each social group

to exercise their own traditions with dignity.


→ Where existing facilities such as graveyards are inadequate, alternative

locations or facilities should be provided.

→ The affected community should also have access to materials to meet the needs

for culturally acceptable funeral rites.





The following items are recommended for inclusion in your basic disaster supplies kit:


→ Three-day supply of non-perishable food.

→ Three-day supply of water one gallon of water per person, per day.

→ Portable, battery-powered radio and extra batteries.

→ Flashlight and extra batteries.

→ First aid kit and manual.

→ Rope, axe, 3 meters of strong cloth like lattha and knife.

→ Sanitation and hygiene items (moist towelettes and toilet paper).

→ Matches and waterproof container.

→ Whistle.

→ Extra clothing.

→ Kitchen accessories and cooking utensils, including a can opener.

→ Photocopies of identification cards.

→ Cash and coins.

→ Special needs items, such as prescription medications, eye glasses, contact

lens solutions, and hearing aid batteries.

→ Items for infants, such as formula, diapers, bottles, and pacifiers.

→ Other items to meet your  unique family needs.





We cannot control the amount of rain, but we can control how to manage rain water usefully.

Many countries receive more than 20 times the rainfall we have every year. They do not get flooded and drown. They use the rain water to generate electricity, increase agriculture, make forests by planting trees and fish farming. It is time we learn to manage what nature bestows upon us and thereby transforming rain into a blessing for ourselves.