Devastation in the Philippines

Ravaged by Typhoon, Philippines Faces Threat of Serious Diseases

A corpse was carried on Thursday to a mass grave in Tacloban, the city of 220,000 that was flattened by the storm that made landfall a week ago. The number of dead still remains uncertain.

By RICK GLADSTONE

Published: November 14, 2013

The aftermath of the Philippines typhoon is now threatening the country with outbreaks of debilitating and potentially fatal diseases, including some thought to have been nearly eradicated, because of a collapse in sanitation, shortages of fresh water and the inability of emergency health teams to respond quickly in the week since the storm struck, doctors and medical officials said Thursday.

Illnesses including cholera, hepatitis, malaria, dengue fever, typhoid fever, bacterial dysentery and others that thrive in tropical, fetid environments, where sewage and water supplies intermingle, could form what doctors fear is the disaster’s second wave. They predicted that leptospirosis, a parasitic disease endemic to the Philippines, could surge. And some said they would not be surprised to see a return of polio. The Philippines is part of an area of the western Pacific declared polio-free by the World Health Organization nearly 14 years ago.

Medical aid groups on the ground in Tacloban, the city of 220,000 that was flattened when the storm made landfall a week ago and that only began to bury its dead on Thursday, have already expressed alarm over the risk of widespread tetanus infections among survivors wounded by shards of corrugated metal and splintered wood.

Some aid groups have already reported exhausting their initial supplies of vaccine to thwart tetanus, a potentially fatal bacterial infection that can cause painful muscle contractions, the inability to swallow and the locking of the jaw. “The population is at increased risk of tetanus as well as outbreaks of acute respiratory infections, measles, leptospirosis and typhoid fever,” the United Nations Office for the Coordination of Humanitarian Affairs, the main international conduit for distributing relief to the Philippines, said on its website. The basic health infrastructures “are severely damaged in the worst affected areas and medical supplies are low.”

Nearly 4,000 people are known to have been injured in the storm, the Philippines government said Thursday on its typhoon disaster website, which puts them at immediate risk of infections and contagion. Relief groups consider the injured figure low because many areas destroyed in the storm have yet to be surveyed on the ground.

Doctors Without Borders, the Paris-based medical aid group that has sent emergency teams into outlying regions of the Philippine archipelago not reached by others, said Thursday that survivors on many islands were in need of everything, especially fresh drinking water.

Esther Sterk, a physician with the group that was helping to assess the immediate needs, said a damaged hospital in Roxas City, in northern Panay Island, was bracing for patients afflicted by contagious diseases. “They are already seeing cases of respiratory infections and diarrhea, and we expect the number of cases to increase,” Dr. Sterk said in an emailed update.

Frank Bia, the medical director of AmeriCares, which has sent an emergency shipment to the Philippines that includes antibiotics, pain relievers and other supplies, said in a telephone interview that the lack of both fresh water and solid-waste disposal systems had created a potent incubator for fecal contaminants that spread cholera, dysentery and, “down the road, even an outbreak of polio.”

Dr. Bia, an infectious disease specialist who treated patients in the Haiti earthquake of 2010, said the watery geography of the Philippines was already a natural host of both human and animal-borne diseases, now made worse by the absence of latrines and functioning sewage disposal systems. “Everything is becoming a big mixture,” he said.

Reports of the death toll from the disaster appeared to grow more confusing on Thursday. The government’s Official Gazette reported 2,357 dead, while the United Nations Office for the Coordination of Humanitarian Affairs reported 4,460 deaths.

President Benigno S. Aquino III has said he believes the initial estimate that 10,000 people may have been killed was exaggerated and that the fatalities might be closer to 2,500.

On Thursday the police official considered responsible for the 10,000 estimate, Chief Superintendent Elmer Soria, was “relieved from his post,” the official Philippines News Agency reported.

The top United Nations official responsible for coordinating the aid, Valerie Amos, suggested in remarks to reporters in Manila on Thursday that the scale of the disaster had been underestimated, and she acknowledged that some places remained without help six days later.

“I very much hope that over the next 48 hours that will change significantly,” she said. “I do feel that we have let people down.”

Keith Bradsher and Austin Ramzy contributed reporting from Tacloban, the Philippines.

This article has been revised to reflect the following correction:

Correction: November 15, 2013

An earlier version of this article misstated the contents of an emergency shipment sent to the Philippines by AmeriCares. It includes antibiotics, pain relievers and other supplies, but no tetanus vaccine.

A version of this article appears in print on November 15, 2013, on page A8 of the New York edition with the headline: Ravaged by Typhoon, Philippines Faces Threat of Serious Diseases.

Source: http://www.nytimes.com