The survivors of the tsunami in South Asia face a long and fairly predictable list of threats to their health, starting with injuries sustained in the event itself, to water- and...

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The survivors of the tsunami in South Asia face a long and fairly predictable list of threats to their health, starting with injuries sustained in the event itself, to water- and insect-borne infections in the ensuing weeks, and culminating for some in long-term mental illness from the psychic trauma and loss, experts say.

How well people fare will depend in large part on decisions being made in the next few days or weeks as local health authorities and outside agencies work frantically to provide water and rudimentary sanitation to the homeless and destitute.

For reasons not entirely understood, natural disasters are rarely followed by epidemics of communicable disease and very high mortality frequently seen in man-made catastrophes such as civil wars, genocide and involuntary displacement of whole populations.

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Nevertheless, the tsunami disaster carries within it some extremely dangerous elements, notably the large numbers of now homeless survivors, many of them poor and some marginally nourished.

“It’s how they are displaced and where they then congregate that will be the defining factor,” said Mark Keim, a disaster-medicine specialist at the U.S. Centers for Disease Control and Prevention in Atlanta.

Aceh: “Special case”

The World Health Organization believes 10 percent of the population of the Aceh region of western Indonesia — about 500,000 people — are at “epidemiological risk” of serious health consequences, said David Nabarro, head of the WHO’s crisis office.

“Because Aceh has had this long-term civil strife, we think the health infrastructure is in a very, very bad way. We have to treat it as a sort of special case,” Nabarro said. The WHO has sent 20 “emergency health kits,” which contain enough medical supplies to serve 10,000 people for three months, to Indonesia.

Large numbers of corpses themselves pose little, if any, health threat. Putrefying flesh does not create disease-causing pathogens or spread them.

The real danger is from infections already present in the population at low rates that can be spread rapidly in the absence of proper sanitation.

Among the waterborne ailments linked to floods, the WHO cites bacterial and viral diseases such as cholera, typhoid fever, hepatitis A and leptospirosis, the latter of which can be spread through the urine of rodents attracted to flood debris.

A parade of maladies

The first to appear are infections such as cholera that cause profuse, watery diarrhea, which can lead to rapid dehydration and death. The disease arises when drinking water is contaminated by the feces of people carrying the pathogens. Treatment in all but the very worst cases consists of drinking a mixture of salt, sugar and water, called “oral rehydration therapy.”

Somewhat later, usually three weeks or more after a disaster, dysenterylike illnesses that cause bloody diarrhea and fever appear. They also are caused by intestinal bacteria — members of the Shigella genus are the classic ones — and are transmitted in fecally contaminated water. Treatment, unlike that for choleralike diarrheas, is primarily antibiotics.

Another illness spread by fecally contaminated water is hepatitis A, a liver disease caused by a virus.

Malaria and dengue, two mosquito-borne diseases made more pervasive by standing water and crowding, may also increase, experts said. Vast piles of debris that hold both rainwater and water that came in the inundation give mosquitoes new places to breed.

“I wouldn’t be surprised if we bring in a certain amount of malaria therapy and insecticide-treated nets” for sleeping under, said Nabarro.

Measles and respiratory diseases, including bacterial pneumonia, traditionally take high tolls in refugee camps, especially among infants, toddlers and the elderly.

Many waterborne diseases are preventable with low-tech solutions such as bleach tablets and other substances that can purify contaminated water.

The WHO was quoted by Newsday.