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Patients with Dengue fever in an hospital in the Swat Valley
Image: Adnan Gran

Poverty breeds sickness

Mirjam Gehrke / jlw
September 5, 2013

Sub-standard healthcare increases the risk of a crisis following a natural disaster. But developing countries lack the money to ensure an adequate healthcare system. Should new demands be made to donor countries?


Floods that beleaguered southern and eastern Germany this summer killed eight people. The flood waters that swept through Pakistan in July and August took 1,700 lives. At the same time, the risk of natural disasters in the two countries is comparable: about 11 percent of Germans and Pakistanis live in regions prone to natural disasters.

Earthquakes, hurricanes, floods or droughts are natural phenomena. Whether they become a disaster depends on how well prepared a country is for such an event. That is the key message of the WorldRiskReport 2013, which was presented on Wednesday (04.09.2013) in Bonn.

Patients diagnosed with cholera receive treatment at a medical center run by Medecins Sans Frontieres.
Haiti has the highest rate of cholera infections in the worldImage: Reuters

"The extent to which a disaster affects people depends largely on the health of the population. And also how well medical care functions in crisis and disaster situations," said Peter Mucke, director of Alliance Development Works, which released the report.

"In the event of an extreme natural disaster, those who know what to do have a better chance of survival, Mucke said. As an example, he cited the management of diseases such as cholera: "In regions where infrastructure and hygiene are a problem, you have to expect there will be an outbreak of cholera in a disaster. You can prepare for that."

The consequences of a lack of preparation can be seen in Haiti. Before the 2010 earthquake, the country was free of cholera. Today, it has the highest infection rate in the world.

Millions unable to access clean water

Prevention is not expensive: Mucke calculates that a toilet in a Kenyan school costs between 475 and 950 euros ($626 – $1,252) and a well for 80 families in Ethiopia 1,900 euros. Supplying a family of six with water from the well would cost 24 euros a year. But rather than take preventative measures, those responsible often only intervene once it's too late, Mucke said.

Man accessing water from a tap.
Access to clean drinking water is critical to controlling diseaseImage: Henning Heide / Viva con Agua

Access to safe drinking water and adequate sanitation is extremely important for hygiene and reducing the spread of disease. Even so, nearly 700 million people worldwide do not have access to clean drinking water, and 2.5 billion people lack access adequate sanitation.

Every day one billion people answer the call of nature without sanitary facilities, two-thirds alone on the Indian subcontinent, said Thomas Kistemann of the Institute for Hygiene and Public Health at the University of Bonn. On the outskirts of villages, for example, it can mean people to come into direct contact with others' feces. In such circumstances, there is no possibility to clean the hands or body after defecating, Kistemann said, adding that it contaminates the environment, the water, the food and also the air. Thus, improving water supplies and sanitation infrastructures is an important task for development work focussed on health and safety, he said.

Calls for global solidarity

Access to health care is also a problem in many emerging and developing countries.

"Every year hundreds of millions of people are financially ruined because they have to privately fund health care for themselves, their children and their families," said Thomas Gebauer from the aid organization Medico International, also a member of the Alliance Development Works. "They go into debt, take out microloans and never get out of this vicious cycle," he added.

Area showing human waste having been deposited
Where no sewage systems exist, feces are often disposed of in open channelsImage: picture-alliance/dpa

In countries like Nigeria, India and Bangladesh, people must have to pay more than half their medical costs out of their own pocket. "Even if governments wanted to, many countries in the South would not be able to provide financial assistance for the entire population," Gebauer said. That's why thought needs to be given to guarantee international healthcare financing with mandatory financial compensation," he added. In other words, richer countries should provide funding to poor countries to bolster their health care systems.

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