Send to a friend
One month after the 7.8 magnitude earthquake that devastated large parts of Nepal, the UN renewed its call for US$423 million to continue providing urgently needed relief. The earthquake and its high-magnitude aftershocks killed over 8,000 people and injured around 22,000, according to UN estimates, and many people still lack food or shelter. 
Among those needing help, people with disabilities are particularly vulnerable. Last month, the National Federation of the Disabled, Nepal — the country’s umbrella organisation for disability charities — urged those responding to the earthquake to also consider disabled people, and to make relief distribution, shelter and information more accessible for people with pre-existing disabilities.
But what about those left with disabilities as a result of natural disasters? Research shows that, on average, there are three injuries to every fatality in a natural disaster — with injury most frequently due to falling debris, water immersion or post-disaster infection. 
Falling debris often causes blunt force trauma, which can lead to amputations, spinal injuries, brain damage and other bone or joint injuries, potentially causing long-term disabilities. 
This can have a devastating impact on people’s lives and livelihoods. Two years after the 2010 earthquake in Haiti, my team undertook a survey to discover the prevalence of disabilities among people in Port-au-Prince. We found that the earthquake was the second leading cause of disability (after communicable and non-communicable diseases). 
Those disabled during disasters tend to be neglected. Part of the problem is that in the immediate aftermath of a disaster, when available resources are quickly overwhelmed, health teams can struggle to collect data on those they treat. Even health centres that keep detailed patient notes in ordinary circumstances may fail to keep records and take down contact details. This has a knock-on effect on follow-up care: patients unregistered at the outset are far less likely to be seen later, when they need secondary and rehabilitative care to adapt to disability caused by injury. 
So what can be done? A good first step would be to have robust surveillance and follow-up mechanisms to track and monitor patients, sitting alongside well-resourced rehabilitative sectors to provide long-term care, such as psysiotherapy and psychosocial support.
Ideally, such surveillance infrastructure would be permanently in place in high-risk countries, so that, when disaster strikes, authorities and services are prepared and more resilient.
But action can also be taken after disasters to improve cross-sector collaboration and streamline the surveillance of people with new disabilities. An easily downloadable database for post-disaster rehabilitation service provision and follow-up could provide a simple and practical way to collect and share data in an emergency. And clear registration points run by designated teams can be effective. For example, the charity Handicap International has set up a ‘reception point’ in a Nepal hospital to register those with disabilities and new injuries, and is collaborating with local partners to ensure patients get follow-up care long after the emergency response phase is over.
These surveillance tools and techniques are simple, but they can be the difference between people getting the help they need — or falling through the cracks, with devastating consequences.
Islay Mactaggart is a research fellow in disability and global health at the International Centre for Evidence in Disability, part of the London School of Hygiene & Tropical Medicine, United Kingdom. Before joining the centre in 2011, she worked for various disability and development organisations in Africa, Asia, the Caribbean and the Middle East. She can be contacted on [email protected] and is on Twitter @IslayMactaggart
 Nepal: 2015 earthquakes (The UN Refugee Agency, accessed 9 June 2015)
 Jan D. Reinhardt and others Disability and health-related rehabilitation in international disaster relief (Global Health Action, 16 August 2011)
 R. Eldar Preparedness for medical rehabilitation of casualties in disaster situations (Disability and Rehabilitation, December 1997)
 Lisa Danquah and others Disability in post-earthquake Haiti: prevalence and inequality in access to services (Disability and Rehabilitation, 1 May 2015)