Relief: Is there a Difference in How We Rise?: A comparison of the medical relief efforts among areas recently affected by natural disasters

BY TOMEKA FRIESON

August 25, 2017, was a day of unanticipated shock and grief for many Americans. Texas had been struck by Category Four Hurricane Harvey and, during those next four days, would experience extensive damage to its people, places, and infrastructure all across its southern region.¹ On August 29, 2017, when the torrential rains terminated, and the totality of damage could be determined, it was surmised that Hurricane Harvey’s 52 inches of rainfall—greater than waist-high on many individuals—and subsequent extensive flooding had left in its wake 12,700 destroyed homes and 190,300 others with varying degrees of damage; 738,000 individuals applying for financial assistance from the Federal Emergency Management Agency; 10,000 citizens trapped in their flooded homes or highways; 37,000 Texans in shelters; 180 billion dollars in damage; and 82 citizens dead as of September 17, 2017.^2,3 In light of Hurricane Harvey’s categorization as the most catastrophic hurricane to have taken place in the United States to date, there is no doubting that human health, sanitation, and medical needs were impacted by this natural disaster. Rather, the question remains the extent to which Texans’ medical needs have been fulfilled by volunteer and relief efforts across the nation. The adverse impact upon Texas citizens has been—and currently continues to be—expansive, especially in terms of physical and mental health, sanitation, and other public health issues. 

Short-term worries for recipients and responders of the flood relief efforts include the introduction of malicious microbes and mosquito-borne diseases due to a prolonged presence of stagnant water; outbreaks of E. coli infections or similar diseases as a result of scarce availability of food or potable water; presence of mold on consistently wet, non-waterproofed infrastructures; lack of proper sewage drainage; and mental health conditions, such as post-traumatic stress disorder and depression.⁴ Other public health issues still remain. The widespread presence of floodwaters has restricted access to medications for individuals in constant need of a prescription, especially for those living with hypertension, diabetes, and/or asthma. And since Texas has the lowest health insurance rate in the country, resources by which individuals could access those medications are, consequently, extremely limited. Referring to Hurricane Harvey’s impact on public health in Houston and its surrounding cities, author Peter Hotez in an interview with the Washington Post deemed the Gulf Coast (the area of the US where Hurricane Harvey’s destruction took precedence) as “America’s vulnerable underbelly of infectious disease,” a phrase that reigns true if taking into account the citizens’ generally low socioeconomic status, high levels of transportation, and the ever-increasing effects of climate change evident within the region.⁴ Despite its characterization as a region of lower socioeconomic status, Texas, and particularly Houston, the city most drastically affected by Hurricane Harvey, is still situated within the United States, one of the world’s most developed countries, and, as such, possesses designated funds particularly allocated toward disaster relief aid.

Exactly two weeks earlier and 8,700 miles around the world from Houston, Texas, citizens of Bangladesh were experiencing the peak of what turned out to be a heart-wrenchingly deadly early monsoon season that left over 1,200 dead; nearly 1,500,000 acres of farmland partially damaged; and close to 25,000 acres of farmland completely destroyed by floodwaters.^5,6 Similar to the devastation caused by the catastrophic flooding in southern Texas, the impact of the natural disaster on the public health of Bangladeshi citizens was immense: as of August 31, 2017, 51,000 Bangladeshis had been displaced; children had been unable to attend school indefinitely; citizens lacked clean drinking water; individuals became more susceptible to mosquito-transmitted diseases such as malaria, Japanese encephalitis, and dengue, due to presence of stagnant water; and the food was so scarce that even farmers were left with nothing.^6,7 With this degree of devastation, the need for aid in Bangladesh was the same—if not greater—than that of Texas. But with 32% of Bangladeshis living below the national poverty line and no developed country, such as the United States, to either economically or materialistically support the impoverished country, the question became how, when, from where, and at what time would aid be received from any outside volunteer or relief organization.⁷ 

September 20, 2017, the day that Hurricane Maria made landfall in Puerto Rico, proved to be a horrific and infamous day in Puerto Rican history. The ultra-powerful Category Four hurricane and ensuing torrential rainfall and flooding was one of the worst to have ever occurred, leaving an initial 1.87 million people without sanitary drinking water; 8,800 in refugee shelters; 49 dead as of October 20; and the island’s 69 hospitals pining for functionality amongst the numerous power outages and blocked roads.^8,9  With 30 percent of people on the island still at a loss for even the most basic necessity of clean water as of October 19, though, a humanitarian crisis of drastic proportions could and did immediately ensue.⁹ Aside from the overbearingly dire need for potable water, limited food, fuel, cell service, and electricity for life-saving or diagnostic hospital equipment left the island in a situation in which help was desperately needed.¹⁰ And in addition to the similar aftermath experienced by both Texas and Bangladesh, a deadly bacteria outbreak of leptospirosis linked with the lack of running water also took hold in some hospitals around the island.⁹ Yet despite Puerto Rico’s dire need for assistance and the island’s status as a commonwealth of the United States, Puerto Rico’s disaster relief efforts have been some of the most criticized to have ever occurred—be it that the aid delivered was late in arriving, or not enough monetary resources were dedicated toward staving off total mayhem in the first place. This left the US commonwealth still, quite literally, in the dark and much volunteer and relief work to be done in order to get the island back to its normal functionality.

The purpose of this article is to investigate the absence or presence of disparities amongst relief efforts for natural disasters in less developed countries, such as Bangladesh, as compared to more developed countries, such as the United States—and where Puerto Rico, a developing US commonwealth, fits into the overall picture in the quickness and completeness by which the island received disaster relief aid. In order to best elucidate the global health impact and potential relief disparities between the three territories’ governments, though, human geographical terms, such as more developed country, or MDC, and less developed country, or LDC, are referred to in order to elucidate the fact that disparities in government economies may lead to disparities in healthcare access. Specifically within this article, then, focus will be placed on the medical aid and resources provided in each of the three public health-economic events. For instance, while Texas, Bangladesh, and Puerto Rico were all affected by drastic flooding that adversely affected the territories in similar ways, this article aims to find any disparities in the relief responses and aid received and surmise the potential impact of this factor on the territories’ future prosperity. What’s more, this article not only investigates the quantity of organizations that responded in each instance, but also how the same organizations responded in each of the three different cases.

In general, the resources through which disaster relief aid is accomplished differ between more and less developed countries. MDCs, for example, enjoy higher per capita incomes and, consequently, have excess capital, or funds, that can be allocated toward disaster relief programs, such as the US’s Federal Emergency Management Agency, or FEMA. For LDCs, on the other hand, capital is scarce and, while the countries’ governments may be able to allocate a small percentage of the country’s resources toward a disaster relief fund, any unexpected natural disasters, such as what occurred in Bangladesh, may quickly deplete that fund, forcing the LDC governments to search outwardly for financial aid in their time of need. In addition to the economic differences between the two country categories, characteristics of the MDC’s and LDC’s food production and supply culture can come into play in terms of natural disasters and their global health impact. Because MDCs typically have adequate sources of, and may in some cases experience an overconsumption of, food, damages to the food supply by sudden natural disasters would not permanently debilitate the country or lead to mass malnutrition. Such is not the case for LDCs, though, in which food supplies are generally low, farming is for subsistence, and malnutrition is not a rare occurrence. When unanticipated catastrophes hit these areas, then, damages to the food supply can be devastating and cause even more loss of life. Furthermore, because MDCs are, as their name describes, more developed, these countries typically have a much greater access to medical care and greater levels of sanitation as compared to LDCs, where overcrowding and little sanitation may already provide the grounds needed for the spread of infectious diseases.¹¹ 

Comparing MDCs to LDCs, then, there is reason to wonder whether areas struck by disasters governed by MDCs receive aid and have needs addressed at a generally faster rate than those of LDCs. However, in analyzing the Texas-Bangladesh situation in particular, a complication exists that may serve as a divergence from the general trend of MDC versus LDC access to aid: both the Texan and Bangladeshi floods occurred at the same time on different sides of the world and medical aid, consequently, had to be divvied amongst the two disasters. The question still remains, though, whether, in the wake of having to split disaster relief resources, one country still received more aid or resources than the other. In other words, is there a fundamental difference in how we rise from the devastation of natural disasters in terms of administered relief efforts?

In the case of Texas’s Hurricane Harvey flood, disaster relief aid came predominantly from within the United States, a phenomenon that occurred not only because the United States is an MDC, but also because, as the Washington Post article entitled “Dozens of Countries Offered Help after Hurricane Katrina. After Harvey, Not So Much,” suggests, the currently charged political climate may have deterred some foreign countries from offering money or supplies, instead only extending condolences to those affected.¹² Nevertheless, the internal disaster relief effort for Texas’s natural disaster was quite profound: rallying the support of the local, state, and federal governments, Texans received aid from 300 volunteer organizations; rescues for over 122,000 individuals; medical care for over 5,000 patients; over six million meals and bottles of water collectively; thousands of hygiene kits, blankets, and cots; and aid from numerous federal organizations, such as the Department of Defense and the Environmental Protection Agency. Particularly of interest is the response of the American Red Cross, which provided over 900,000 meals and 1 million snacks, deployed more than 3,000 volunteers and 171 emergency response vehicles, and supported more than 100,000 Texans with over 45 million dollars in financial aid for the provision of immediate needs.¹³ 

On the other hand, in Bangladesh, the medical response and relief efforts were much more of a local and international effort than a federal one. Internationally, organizations such as UNICEF’s Children’s Emergency Fund, Save the Children, and UK-based Oxfam made great contributions by providing hygiene kits, solar lamps, and fleece blankets for those in need and equipping more than 180,000 victims with food and clean water.^14,15 Furthermore, under the guidance of the Red Cross’ partner, the Bangladesh Red Crescent, food was distributed to over 20,000 flood victims.¹⁶ In spite of this, local aid remained the primary source for disaster relief in Bangladesh. Because local organizations were particularly able to understand the degree to which the catastrophic floods had wreaked havoc upon the country’s public health, sanitation, and economic institutions, and, being so close to the source of devastation, they were able to focus their resources on the particular needs of individuals devastated by the monsoon floods.

The truth of the matter, however, is that in being backed by an MDC who has a federally recognized and well-constructed plan of action for disaster relief, Texas’s prosperity in terms of individuals’ public health will be better off in the long-run. For Bangladesh, on the other hand, volunteer organizations are still struggling to find enough clean water to provide the victims.

Bangladesh started off in conditions much less conducive to rapid recovery should a natural disaster strike, and when one finally did, the resources and aid just were not in place in order to aid in a swift recovery following the devastation.

On account of these two disparate outcomes as a result of available aid, then, the question becomes: where does Puerto Rico, as a developing territory that is also a commonwealth of a more developed country, fit into the grand scheme of disaster relief response? 

CNN reports that even though Puerto Ricans are provided with 10,000 containers worth of food, water, and medical supplies, access to these resources is very limited since the trucks that  need to transport them to where they need to be are significantly impeded by totally razed infrastructure and destroyed roads. And even with this, fuel shortages and damaged cell towers additionally prevent drivers from reaching their destinations. In other words, the supplies are where they should be—but can’t be where they need to be. In lieu of the lack of access to supplies, then, local efforts were made by gas stations and supermarkets to ration out grocery products as much as possible.¹⁷ And while organizations such as the Red Cross are on the ground to facilitate relief efforts by distributing food and bottled water, two boxes of food divvied amongst eight people does more than enough to explain why Puerto Rico is still in the midst of an extreme humanitarian crisis. Many Puerto Rican citizens point out that there really exists no structural organization in the distribution of relief supplies; most of the matter is left up to the serendipity of those who happen to be around when supplies are rationed.¹⁸ In terms of volunteer forces on the ground in order to help ease the burden of devastation, organizations such as United for Puerto Rico, UNICEF, Save the Children, and One America Appeal are doing what they can to funnel money and supplies to the areas that need them most.¹⁹ On an international level, furthermore, the response is quite strong, with Puerto Rico receiving aid from numerous global organizations aimed at reducing the burden of people living within natural-disaster-torn areas. Red Cross volunteers, for example, are continually distributing hygiene and sanitation kits along with the highly sought-after food and water, yet emergency shelters are still needed by many in the Puerto Rican population.²⁰ Federally, the US’s FEMA has approved for more than 500 million dollars in assistance to be distributed throughout various sectors of Puerto Rico, whether it be for critical and immediate assistance, sanitation amelioration, or small business improvement.²¹ All in all though, much of the aid being rendered has yet to fully reach its recipients.

So how do you categorize the relief efforts of an island where the supplies are readily available, but not readily accessible? Does the response to Puerto Rico’s natural disaster more closely fit the mold of an LDC response, an MDC response, neither, or both?

After investigation, it can be concluded that the case of Puerto Rico is truthfully a middle ground, one in which aspects of both LDC and MDC responses come into play to create the situation currently observed throughout the country. Specifically, in terms of Puerto Rico’s economic status and the amount of aid the people of the island truly receive, Puerto Rico mimics much more closely the model of a less developed country, one in which the island’s economy must look to external sources to obtain sufficient aid and relief, and in which infrastructure—the washed away roads and lack of widespread electricity in particular—prevents the extensive distribution of aid for even the most basic needs, such as potable water. On the other hand, Puerto Rico’s disaster relief request initiative can be said to mimic that of an MDC in terms of the publicity and global recognition rendered to the cause. Similar to what happened after the extent to which floodwaters had decimated southern Texas following Hurricane Harvey had been realized, American media quickly recognized and made an effort to publicize the destruction caused by Hurricane Maria’s floodwaters in Puerto Rico. In simply talking about the devastation that had occurred in the US commonwealth so readily and openly, more citizens in both the United States and abroad became aware of the situation and were, consequently, willing to send money and supplies to aid in relief efforts.

If, then, Puerto Rico is a commonwealth essentially stuck between two worlds and, just like Bangladesh and Texas, is in dire need of supplies and financial assistance, what is the next step that we can take to ease the burden of destruction caused by natural disasters and prevent as catastrophic of repercussions in the future? Firstly, it must be asked why and how these catastrophes occurred in the first place. And while the onset of severe meteorological events cannot always be foreseen (yet can be mitigated by human behavior that reduces the progression of climate change), preparedness can—and, consequently, should—be. In fact, in the cases of both Bangladesh and Puerto Rico, the issue at hand was not the governments’ improper allocation of monetary funds toward disaster relief and emergency aid, but rather a general lack of resources available in order to do so in the first place. A possible solution to this plight would be to institute a baseline disaster preparedness module in even the least developed of countries in order to ensure that territories the world around had a least a few funds allocated toward relief should disaster strike. Turning this solution into a reality, though, may pose a challenge since its establishment requires the cooperation of other countries to channel funds and resources into preparedness for those who have yet to establish a plan. In increasing disaster preparedness, we could increase disaster response and, in turn, more quickly and effectively improve the health and prosperity of victims after such crises.

Nevertheless, we can all immediately play a part in contributing to rehabilitation and relief of individuals living within natural-disaster-torn areas of Texas, Bangladesh, and/or Puerto Rico, as well as others. Food, bottled water, proper sanitation, and shelter still remain highly sought-after in each of these areas, yet less developed regions such as Puerto Rico and Bangladesh are experiencing particularly catastrophic hardship due to a decreased access to financial amenities, as well as washed out infrastructure that prevents even an adequate distribution of relief supplies. Consequently, to find out what we each can do to minimize the negative impact of these natural disasters on the citizens of these territories and help motivate disaster preparedness efforts in the future, visit https://reliefweb.int/organizations#content for a comprehensive list of relief organizations. Any aid rendered is a step toward future prosperity.

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References

1. US Department of Commerce (2017). Major Hurricane Harvey – August 25-29, 2017. National Weather Service. Retrieved from http://www.weather.gov/crp/hurricane_harvey,
2. Gallagher, J.J. (2017). Hurricane Harvey Wreaks Historic Devastation: By the Numbers. ABC News. Retrieved from http://abcnews.go.com/US/hurricane-harvey-wreaks-historic-devastation-numbers/story?id=49529063.
3. Amadeo, Kimberly (2017). Hurricane Harvey Facts, Damage and Costs. The Balance. Retrieved from https://www.thebalance.com/hurricane-harvey-facts-damage-costs-4150087.
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21. US Department of Homeland Security (2017). FEMA Approves More than $500 Million in Assistance to Puerto Rico. Federal Emergency Management Agency. Retrieved from https://www.fema.gov/news-release/2017/10/23/4339/fema-approves-more-500-million-assistance-puerto-rico.