Michael Abrahams | How hurricanes affect our health

Hurricane Melissa departed our shores three weeks ago. The death toll, at the time of writing this article, stands at 45, but this figure does not fully reflect the devastating effect the storm has had on the health of our populace. Health is defined as physical, mental and social well-being, and Melissa has affected all three for many.

While we see the immediate and short-term effects, we must also be aware that a disaster of this magnitude will also have long-term consequences. For instance, a 2024 American study found that thousands of indirect deaths following a severe storm can continue to occur up to 15 years after the event, with the figure being up to 300 times greater than official death counts. This underscores the importance of long-term healthcare in the aftermath of a hurricane, as well as the need for sustained efforts to address its health impacts.

In the days and weeks following a hurricane’s passage, the health impacts often shift. The immediate effects are apparent, such as physical injury from debris and other objects mobilised by winds or water, and drowning from storm surges and flood waters. Other hazards include electrocution from downed power lines and exposed electrical wires and equipment, as well as carbon monoxide poisoning from exposure to running generators in enclosed spaces. Skin injuries can also occur following exposure to floodwater contaminated with corrosive chemicals. Also, pregnant people who experience a hurricane are at an increased risk of preterm birth.

The disruption of the healthcare infrastructure poses a significant risk. Severe storms often damage hospitals and other health facilities, interfering with their ability to provide care to those in need. Even when facilities remain open, damaged roads may prevent safe access to care. This can lead to the interruption of schedules for medical interventions such as dialysis and chemotherapy, difficulty in refilling prescriptions, and postponement of life-saving surgical procedures and these inconveniences can significantly increase morbidity and mortality. Storms can also disrupt healthcare supply chains, leading to health impacts at locations distant from the site of the damage.

INFECTIONS

Infections often remain a common sequela after severe storms. Skin and soft tissue infections (SSTIs) are not uncommon, as skin injuries can easily become infected due to the unhygienic conditions that often exist. Tetanus can occur in unvaccinated individuals if the skin is pierced by objects contaminated with the bacteria that causes the disease. Poor hygiene, sanitation, and access to clean water and uncontaminated food also increase vulnerability to a variety of common communicable infectious diseases. Exposure to floodwater contaminated by human or animal waste can increase the risk of gastrointestinal illnesses such as gastroenteritis and typhoid, and also Hepatitis A.

Stagnant water following a storm is an excellent breeding ground for mosquitoes, which can carry dengue, chikungunya, Zika and other mosquito-borne illnesses. One of the commonest infections that flares up after flooding is leptospirosis. The infection is contracted when non-intact skin, such as abrasions and lacerations, and mucous membranes (e.g. conjunctiva, nasopharynx) come in direct contact with water contaminated by the urine and other body fluids of infected rodents. Flooded homes can facilitate the growth of mould and mildew, leading to not only respiratory infections, but also allergies and can trigger or worsen pre-existing bronchial asthma.

Mental health disorders can also be precipitated or exacerbated following such a disaster. For example, American studies after Hurricane Katrina showed that 30 to 50 per cent of survivors had post-traumatic stress disorder (PTSD), and 36 per cent of children showed severe emotional disturbances. After Hurricane Sandy, PTSD was seen in 20 per cent of residents, while 33 per cent reported depression and 46 per cent had symptoms of anxiety. Communities that experience a hurricane and the resulting mental anguish are likely to see an uptick in substance abuse and domestic violence.

UNDERESTIMATED

The long-term effects of disasters, such as severe hurricanes, are often underestimated. Additional deaths continue for many years due to worsened chronic disease management after the event, not just because of the disruption of health services, but also from social and economic factors that have major negative effects on health in the future. For instance, more funding may be allocated to rebuilding devastated infrastructure than to health-supporting programs for decades after a major storm. Apart from the deaths, significant morbidity also persists. Chronic diseases, whose management was impaired by the disaster, and mental health impacts can linger for decades. For instance, more than a decade after Hurricane Katrina hit New Orleans, one out of six survivors still exhibited symptoms consistent with PTSD.

Considering these deleterious sequelae, to mitigate negative short-term and long-term outcomes, the relevant authorities must act swiftly. Mosquito and rodent control, sanitation, accessibility to potable water, restoration of electricity, shelter for the homeless and the repair of health facilities must be urgently addressed. Equally important is the provision of psychological support for the many who have been traumatised by the catastrophe.

Those of us living in or visiting affected areas must also protect ourselves by wearing appropriate clothing and gear to minimise contact with contaminated water and other materials. Discard food that has not been properly stored or that may be spoiled. Empty or cover containers with standing water around your home, and use mosquito repellents. Water should be boiled or treated with chlorine tablets in areas where its safety is questionable, and proper handwashing should be practised where possible. Pregnancy avoidance may also be a good idea in the short term in areas where access to medical treatment is compromised, and persons of reproductive age who can conceive should take folic acid supplements to reduce the risk of having babies with spinal defects, as nutrition can be compromised in the aftermath of such a disaster.

In the face of climate change, extreme weather disasters, such as hurricanes, are expected to increase in frequency and intensity, and impact new geographic locations, significantly affecting our health and healthcare systems. We must be prepared.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams