An urban flood event requires immediate measures to ensure that citizens have safe drinking water, including appropriate excreta disposal, disease vector control and waste management. However, during and after a flood event is not necessarily the best time to communicate health messages to individuals and organizations, as they may be dispersed and not have access to the necessary resources. Health Awareness Campaigns are vital ‘soft’ interventions alongside hardware provision (waste water treatment, for example); together they can help preserve public health by increasing preparedness. Health awareness and hygiene promotion campaigns must not be carried out independently from water supply and sanitation, and vice versa.
Floods can make it difficult to maintain dignity and hygiene, and lead to an increase in the risk of disease in the following ways:
- Widespread contamination by fecal material due to destruction, breakage or damage to sewage systems and latrines, and subsequent open defecation
- Contamination of drinking water
- Thick layers of silt, debris and other materials
- Loss or lack of key hygiene item
- Standing pools of contaminated water or sewage
- Rotting corpses (human and animal) can lead to excessive fly breeding or contamination of water sources from insect feces
- Increase in vector breeding
- An adverse psychological impact due to loss, and a sense of despair.
An effective health awareness campaign will provide clear timely advice on how best to protect individual and public health during a flood and will facilitate a two–way dialogue such that feedback from the affected persons directly informs priorities and decision making.
Pre-flood campaigns are vital for risk mitigation and preparedness. Campaigns during, or post-flooding, will reinforce messages and mobilize communities into action to preserve public health.
Key Components of Health Awareness Campaigns
Urban residents may have received little or no previous hygiene education or health awareness training and are likely to be ill-prepared to respond to a flood. When this condition is combined with weak local or municipal government and staff who are themselves ill-prepared, a flood event can result in a complete breakdown of basic public services (water, sanitation and solid waste management) alongside a significant increase in the risk of accidents and disease. As a consequence, even a relatively minor flood can result in a dangerous increase in morbidity and mortality.
It is important to plan health awareness campaigns with an understanding of the type of flooding involved, its anticipated effects, probable duration and the likely impact on the urban population. This planning also has to take into account the current status of public understanding and awareness of health issues, as no two urban situations will be the same. Both the messages and modes of communication should be adapted for the particular situation and for different audiences. The messages should take account of beliefs and attitudes that regarding health, disease and hygiene and should appeal to the interests and priorities of different groups.
The health awareness interventions should be designed with participation and collaboration of all key stakeholders, to ensure that effective messages are developed, and that both clarity and consistency apply to the communication strategy. The relevant government ministries (such as environmental health, social welfare, health, education) should be involved, as well as influential leaders, opinion formers and agencies working in the WASH (the now commonly used acronym used for water supply, sanitation and hygiene promotion) or health cluster. Different sections of the community should participate, including the more vulnerable groups such as low-income groups, women, children, aged and disabled people.
Health awareness is required by three distinct groups of people:
- Municipal staff, volunteers and health professionals
- The general public and in particular vulnerable groups
- Media workers.
When and where to use Health Awareness Campaigns
Any flood-prone city or town would be well advised to invest in a health awareness campaign, both pre-flood and post-flood, irrespective of what type of flood is anticipated. An assessment in advance of the likely public health risks during a flood in that location (including, for example, impacts on water treatment works, or probable disease vectors where appropriate) will guide the design and prioritization of any campaign to make it more cost effective.
An effective public health campaign will reduce death and disease caused by flooding. Specifically, pre-flood health awareness campaigns will:
- Develop knowledge, understanding and build the capacity of municipal staff and volunteers to work effectively and efficiently post-flood, to preserve public health and reduce mortality and morbidity.
- Provide guidelines on key elements of an initial rapid assessment of public health risks and build capacity to institute an appropriate, rapid and coordinated WASH response.
- Protect health service capacity from the impacts of flooding.
- Post-flood campaigns will help preserve personal and public health by giving the public immediately relevant knowledge and awareness to complement the hardware relief interventions.
The health and hygiene information is also applicable in non-flood situations and, as such, will have a knock-on effect of improving public health in general. Health awareness campaigns to deal with urban floods sit very comfortably alongside other, more traditional, health campaigns such as mother and child health, anti-malaria and HIV/AIDs awareness. The same professional staff and volunteers can and should be involved.
Risks and weaknesses
There are few risks associated with promoting health awareness in urban areas prone to flooding. The challenge is to ensure that this is carried out effectively, as far in advance of floods as possible and in close coordination with the structural mitigation and relief interventions.
Cities may face particular challenges, such as providing sanitary excreta disposal options for low income settlements, or maintaining waste disposal services during the flood. Given the relative poverty of many affected municipal authorities and local governments, there may also be issues around obtaining resources to invest in public health flood preparedness, when structural interventions could appear more politically advantageous.
Essentials and key considerations
The affected population should be made aware of their rights and entitlements to relief and recovery operations; this is particularly relevant to the rights to protection for specific groups of persons (such as internally displaced persons; women, children and adolescents; the aged; people living with HIV/AIDs; persons with disabilities; single parent households; ethnic and religious minority groups; and indigenous peoples). IASC (2008) discusses these issues in more detail.
Public health campaigns can only provide knowledge and understanding, which may do little practical good without tangible interventions such as provision of clean drinking water, chlorine tablets or safe waste disposal sites. However, as stressed in this section, without pre- and post-flood ‘soft’ interventions (specifically aimed at promoting awareness of how to preserve health and hygiene during floods), the ‘hard’ interventions are unlikely to be effectively mobilized or, even if mobilized, will by themselves be of minimal use.
Catastrophic outbreaks of diseases are not inevitable after a disaster: they do not spontaneously occur. However, the keys to preventing disease are to be prepared, to educate and motivate both the appropriate officials and the public, and to promote the meeting of basic sanitary needs.