SeriesReducing the health effect of natural hazards in Bangladesh
Introduction
Bangladesh is a country with great geographical vulnerability, with 70% of the population living in regions at risk of floods and 26% in regions at risk of cyclones (figure).2 Not only is Bangladesh plagued with natural disasters, its population density makes it especially vulnerable to high rates of mortality and morbidity. With regard to the effect of natural disasters in south Asia in the 1960s–80s, Bangladesh had fewer events than either India or Indonesia, but had the highest overall mortality.3 However, the death rate from floods and cyclones has substantially fallen (table 1).9 Through both planned and unplanned interventions, Bangladesh has evolved effective strategies to mitigate the damage of natural disasters on human health and development. This success can be linked to several key insights that guide disaster management efforts: (1) identification of and focus on the greatest drivers of mortality; (2) use of each experience in disaster management to inform and improve strategies for future events; (3) designing of interventions that draw on existing social capital and self-sufficiency of the community; and (4) viewing of poverty as a key source of vulnerability in disasters, and support of ongoing poverty reduction and development efforts. Application of these principles has enabled the country to establish and continually improve efforts to prepare for, mitigate, and respond to these natural hazards.
Through a large network of public, civil society, and community stakeholders, Bangladesh has distributed capacities and responsibilities broadly, with mechanisms in place to rapidly move information, goods, and financial resources. Disasters can be drivers of poverty, creating greater vulnerability to future risks. Bangladesh has focused on breaking this cycle by integration of disaster recovery and resilience in its overall strategy of poverty reduction.9 Present efforts to acknowledge changing social and economic demographics, including specific consideration to urban contexts and increasing availability of technology (such as mobile phones), show the ongoing learning and experimentation at the core of Bangladesh's approach. These insights inform a framework that can be applied globally for improved disaster management.
Section snippets
Floods and cyclones in Bangladesh
In general, disasters create several phases of public health needs: immediate rescue, infrastructural rebuilding, long-term livelihood, and health interventions.9 In Bangladesh, floods and cyclones each pose distinct threats to health that need separate consideration. Cyclones, also known as hurricanes or typhoons in different regions of the world, are characterised by sustained, strong winds of more than 63 km/h and the storm surges they create. The high floods of water caused by wind and low
Identification of opportunities for effective intervention
For all natural hazards, the immediate goal is to reduce mortality and morbidity and the longer-term goal is to reduce the time needed to recover and regain self-sufficiency. Natural disasters create an extreme environment in which health is threatened by a few key factors. The strategies for mitigation of the effect of disasters usually fall into three categories: preparedness or risk reduction, readiness, and response. The relative importance of interventions in each category is dependent on
Focus on communities
Community capital can be an important factor to reduce vulnerability and mitigate existing inequalities. Much of Bangladesh's response strategies focus on the community and support existing coping strategies.14 Findings from qualitative research frequently suggest that the community is an important safety net; people are often reluctant to seek shelter if it means separation from a group.16 Informal loans, and sharing of transportation and scarce resources are examples of communities creating
Cyclones
For disaster management, several interrelated systems need to work together in times of crisis, with very little advance notice. Opportunities to pilot or test strategies are restricted. The various responders to cyclones, including local non-governmental organisations (NGOs) and the Government of Bangladesh, have developed a discipline that involved reflection on natural disasters and responses to identify patterns of death to improve its systems for the future. Because storm surges account
Future issues
Geographically, Bangladesh is highly vulnerable to climate change. In the next few years, the country will probably experience more extreme river flooding, more intense cyclones, rising sea levels, and very high temperatures.33 Because crops are affected, food security might emerge as a renewed threat. Urban dwellers will face increased health risks and vulnerability during natural hazards. In early 2013, Bangladesh's risk for an earthquake was emphasised.34 Worldwide, earthquakes account for
Lessons learned
The successes in Bangladesh's approach can be linked to several key insights that guide disaster management efforts: (1) identification and aversion or mitigation of phases with the greatest rates of morbidity and mortality; (2) assessment of previous experiences in disaster management to ascertain opportunity for improvement; (3) recognition of the importance of social capital and self-sufficiency of the community, and designing of interventions to leverage or rebuild it in the context of
Limitations
Comparing outcomes between different disasters can be problematic because the effect is most often dependent on other factors over which human beings have little control. Where a cyclone makes landfall; the time of day it strikes, especially related to tides; and its path will all have a major bearing on the extent of destruction. In Bangladesh, studies examining levels and causes of morbidity are also problematic because data collection is often episodic and has only become more routine in the
Conclusions
Within its resource constraints, Bangladesh has achieved good results in mitigation of adverse effects on health from natural disasters. We believe these results are mainly due to applied insights, including the coordination of poverty reduction with disaster management, learning from each experience, focusing on regions where the effect of interventions is likely to be highest, and focusing on community resilience. We have identified several ways to build on successes to further protect the
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2022, World DevelopmentPlanned sheltering as an adaptation strategy to climate change: Lessons learned from the severe flooding in Anhui Province of China in 2016
2019, Science of the Total EnvironmentCitation Excerpt :CCCM, 2010; Chandanachulaka and Bussarangsri, 2013; Mallick et al., 2010; The Sphere Project, 2018). The international guidance revealed that after the disaster, much can be done to reduce the short-term and long-term health consequences, such as provision of potable water, food, health care, and other necessary relief services, with distribution strategies to ensure that these approaches reach the people in greatest need (Cash et al., 2013; CCCM, 2010; The Sphere Project). For instance, the US study found that the satisfactory provision of water, sanitation, electricity, and housing reconstruction, were associated with a decreased risk of PTSD following hurricane Katrina (Galea et al., 2008).
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