When 2013's Typhoon Haiyan struck the Philippines on November 8th, it measured 300 miles across and was one of the world's most intense tropical storms ever to have hit land.
Almost 100 million people populate the islands of the Philippines in the western Pacific Ocean, according to World Bank estimates, and millions living in coastal areas have been affected by the initial destruction and continuing aftermath produced by the super-typhoon, which delivered:
- Torrential rain
- Winds of over 185mph, and
- A storm surge wave of up to 30 feet.
The devastation is on a par with that brought by the 2004 Boxing Day tsunami in the Indian Ocean - and the medical aid challenges are similar.
Aid agencies say they have learnt a lot from previous natural disasters - the 2010 earthquake in Haiti included - making them better prepared to provide the most effective response. But what are the medical needs and how exactly are they met?
Medical boats and inflatable hospitals
According to a World Health Organization (WHO) report on November 10th, the Philippine Red Cross had estimated that over 1,200 people were killed - but as the picture developed, a November 27th report from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) put that figure at an estimate of 5,200 deaths and nearly 26,000 injuries.
The destruction caused by super-typhoon Haiyan is said to be on a scale similar to that brought by the 2004 Boxing Day tsunami in the Indian Ocean
The total number of people displaced reached 3.5 million, says the OCHA report. Some 1,068 evacuation centres took in about 226,000 people made homeless by the disaster.
The obvious initial emergency has been to treat the wounded and deliver shelter and clean food and water, but there was also the need to reach those people who were already receiving medical attention before the disaster, or who were due to give birth.
Immediate responses, before international agencies can reach the people affected, come from the local people and governments, and charities first work with local efforts to coordinate action.
The Philippines itself - where the 2013 disaster is called Typhon Yolanda - has its own coordinated medical response, including "Doctors on Boats" provided by the Philippine Medical Association, which is calling for donations.
Doctors on Boats is accustomed to delivering medical staff and medicines in similar emergency situations in the Philippines, such as the monsoon floods in August 2012.It has provided over 100 volunteer doctors, nurses, dentists, pharmacists and psychologists.
As international aid then follows in affected areas, measures include setting up inflatable hospitals. Doctors Without Borders (Médecins Sans Frontières), for example, is providing help in an inflatable hospital that it first deployed during the Haitian earthquake crisis in 2010, shown in the charity's YouTube video below.
Doctors Without Borders has an update on its overall Philippines response, which has also included the use of traditional tent hospitals.
After trying to meet the immediate needs, other health threats can develop - but it is a myth to think that one of these is the presence of dead bodies.
Dead bodies are not a major health threat
As confirmed in a fact sheet from the World Health Organization (WHO) about care of the dead in disasters, dead bodies are not the main source of disease and are not responsible for the initial public health threat.
Of course, the widespread sight of dead bodies is highly distressing, and TV journalists tend to refer graphically to the smell of death, but it is a myth that burial should be a priority.
Diseases and infections are not started in rotting bodies that have been killed by the immediate disaster trauma. In fact, survivors are the source of infection, as their own sanitary conditions deteriorate and sources of clean water are disrupted.
Dead bodies only present gastrointestinal infection problems, WHO says, sometimes caused if they contaminate water supplies.
The greater priority for removal of dead bodies is to reduce social and mental distress, but guidance reminds communities affected that there is no need to rush to bury or cremate people, and that time is important for proper identification to take place.
Injury, water-borne diseases, and a lack of normal healthcare
The World Health Organization is responsible for the overall coordination of the medical response to the super-typhoon disaster.
WHO lists complications of injury as the first medical priority, including:
- Tetanus (an infection caused when bacterial spores present in the soil get into wounds)
The consequences of damaged water supplies and sanitation are the next priority. Water-borne diseases that may spread include:
- Cholera (a bacterial bowel infection that causes a large amount of watery diarrhea)
- Shigellosis (another gastrointestinal infection caused by bacteria)
- Hepatitis (liver disease caused by viruses)
- Leptospirosis (bacterial infection from animal urine, usually transmitted through water).
The temporary housing of crowded populations of displaced people may lead to outbreaks of diseases such as measles, which may be dangerous for vulnerable children.
Diseases such as malaria, dengue and Japanese encephalitis (all spread by mosquitos) may become more prevalent, calling for preventive measures.
Over 370,000 women were pregnant or lactating in the Philippines, according to estimates in OCHA's November 17th report - these people need specialized pre-natal, post-natal and child healthcare services.
WHO estimates that at least 15% of childbirths are expected to have complications, yet health services have been severely affected by the super-typhoon. OCHA found that, of 103 health facilities in the regions it had assessed, 48 were not functioning on November 15th.
In the longer term, WHO says: