World Report
Philippines struggles to recover from typhoons
The Philippines is struggling to fight outbreaks of infection in the population after being
battered by two typhoons, which caused massive flooding in the country. Justin McCurry reports.
The Philippines is facing a public health
emergency after being struck by two
ferocious typhoons, aid agencies have
warned, as nearly 1·5 million people
struggle to stave off disease spread
by the worst flooding the country has
seen for decades.
Earlier this week, the Philippines were
granted a respite when a third storm
quickly weakened and brushed the
northern coast of the main island of
Luzon before heading north to Japan.
Aid agencies that had been
preparing to evacuate communities
in the path of typhoon Lupit were
instead able to begin relief operations
aimed at preventing food shortages
and outbreaks of serious disease in
what Josette Sheeran, the head of the
UN’s World Food Programme, called
the Philippines’ biggest humanitarian
challenge in its recent history.
Two super typhoons caused the
worst flooding Manila has had in 40
years when they swept through the
country in quick succession from late
September. More than 80% of the
capital was left submerged, nearby
farmland was rendered useless and
hundreds of thousands of people were
forced to leave their homes.
More than 160 000 people are still
living in unhygienic conditions in
evacuation centres, while WHO says
that 1·4 million people are living in
flooded suburbs. The total number
of people affected by the floods is
reported to be as high as 6 million.
The storms killed almost 1000 people,
most of them buried in mudslides, and
left many thousands more exposed to
disease and food shortages.
The government has been criticised
for failing to prepare for the disasters,
while the international community
is struggling to honour aid pledges.
So far the UN has raised less than a
third of the US$74 million it says it
www.thelancet.com Vol 374 October 31, 2009
needs to provide food, water, shelter,
sanitation, and health care to flood
victims over the next 3 months.
The most urgent threat to health is
an outbreak of leptospirosis, a disease
that is spread through contact with
water contaminated with the urine
“The most urgent threat to
health is an outbreak of
leptospirosis...”
of dogs, rats, and other animals. As
of early this week 175 people had
died from the disease in the Manila
area, while almost 2000 others were
showing symptoms. An emergency
response team from the WHO, including
two epidemiologists and an expert
in leptospirosis, was due to arrive this
week to treat patients in Manila and the
nearby provinces of Rizal and Laguna.
Many of the victims were infected
through open cuts or sores while
wading through dirty floodwater. In
its early stages leptospirosis can cause
vomiting, fever, and rash, with renal
failure and internal bleeding among its
more serious symptoms.
In an attempt to halt the spread
of the disease, the government has
distributed antibiotics offering an
extra layer of protection to 1·3 million
people, but says it still needs outside
help to contain the outbreak.
The local medical response has been
hampered by damage to the health-
care infrastructure, with the few
state-run hospitals that are still open
in Manila saying they are struggling
to cope with the influx of patients. In
the past few weeks the country has
seen as many cases of leptospirosis
as it normally would in a year, local
reports say, while the city’s main public
hospital for infections diseases said
that, at the height of the outbreak, it
ran out of testing kits. Despite signs
that cases of leptospirosis peaked in
mid-October, Merlin, a medical relief
agency, said the conditions are in place
for a “perfect storm of disease”.
“The standing water is creating
the perfect conditions for diseases,
such as dengue fever, transmitted by
mosquitoes”, said Sean Keogh, Merlin’s
emergency health assessor, who
recently visited the Philippines. “Acute
watery diarrhoea, which is endemic to
certain areas of the Philippines, is also
a problem, especially with the poor
sanitation, lack of clean drinking water
and overcrowded conditions.” In
addition, people living in evacuation
centres are susceptible to respiratory
infections, skin disease, fever,
diarrhoea, and infected wounds, the
Philippines health department said.
Latha Caleb, Save the Children’s
country director in the Philippines, said
young children living in evacuation
centres were particularly vulnerable.
“Children in these storm-affected
areas face a host of dangers that pose
a threat to their very survival”, she
said. “It is critical now to address the
lack of sanitation systems and clean
water that are resulting in widespread
illness and disease.”
Justin McCurry
The printed journal
includes an image merely
for illustration
AP
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