eh measures for disease control after emergencies
TRANSCRIPT
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A mother and child heading
for a place, through 'nose-
deep' flood water in
Birshing village, south west
of Guwahati, on July 14.
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Top 10 most important disaster by
number of killed in 2007
Event Country People KilledCyclone Sidar,November
Bangladesh 4234
Flood, July – August Bangladesh !
Flood, July"Se#tember $ndia !3Flood, August %orea &em' (' )e# *!
+eat ave, July South -uro#e and theBal.ans
/*0
Flood, June – July China (' )e#' /3/
-arth1ua.e, August (eru /Cyclone emyin, June (a.isthan 242
Flood and andslides,June
(a.isthan 225
Flood, July $ndia 22/
6otal 303Source:Annual Disaster Statistical review,CRED,Belgium
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Impact
Two illion people !ace "ealt" t"reatsecause t"ey are at ris# o! or e$posed tocrisis condition
Twenty million people or %& countries areactually in crisis Si$ty 'ive percentage ()%*+ o! Epidemic
reported worldwide occur in comple$
Emergencies
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Impact: A Larger Picture
-uman lives
.ivestoc#, ot"er animals
Private property
/unicipal in!rastructure Power0
telecommunicationsin!rastructure
-ealt"0 education assets
1u2arat eart"3ua#eestimate:
4S5 6789 /illion
&irect losses
E$port0 import
Agricultural output
ndustry0 services output
Remittance income
'all in earning potential(due to disaility, traumaetc+
4nemployment
-ealt" "a;ards
1u2arat eart"3ua#eestimate:4S5 )6% /illion
$ndirect losses
.ong
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Mortality due to natural a!ards in
India
Name o7
Country
&eaths caused by natural
disasters
Natural disasters mortality
ratio 8#er !!,!!! deaths9
ndia7997<
799%
799)<
>&&&
>&&7<
>&&%
>&&) 7997<
799%
799)<
>&&&
>&&7<
>&&%
>&&)
>&,?>? >8,)&% @887@ )98 @? )6 7&6 ?
Source: ESCAP Statistical earoo# !or Asia and t"e Paci!ic >&&?:
"ttp:00wwwunescaporg0stat0data0sy>&&?0
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"amaged caused by Mass casualty
#$ents due to %atural "isasters in India
ear Peoplea!!ected
( .a#"+
-ouses uildings,partially or
totallydamaged
Amount o!propertydamage0los
s (Rs Crore+
7998 %>7? 7%)6@&% &?>
7999 %&7? 67&@&)@ 7&>&9?
>&&& %9@6@ >?6)6%% 8&&&&
>&&7 ?8879 8@)8?8 7>&&&
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List of %atural "isasters (Recent Past)
&isaster (lace
Cyclone, 799?, 7999 1u2arat, =rissa
'lood, >&&&, >&&@,
>&&%,>&&?,>&&8
Assam Bi"ar B 1u2arat
=rissa 4ttaranc"al Tamiladu /a"aras"tra
Eart"3ua#e, 799? 7999>&&7>&&@ >&&%
/a"aras"tra /P 4P 1u2aratAndaman icoar FK
.andslide, >&&@ Kas"mir S"imla, ort"east
region
Tsunami, >&&@ Sout" ndia
-eat ave, >&&@ Del"i, -aryana, 4P, Pun2a
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&ealt Issues after a "isaster
A##ro#riate handling o7 the dead $n:ury and disability (sychosocial #roblems ;ater and -nvironmental sanitation Communicable &isease )e#roductive and child health issues Sustaining .ey health care delivery
7unctions, including medicines and critical
medical su##lies $mmuni
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#n$ironment &ealtManagement
During Emergencies
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#ffects of "isaster on 'eneral
#n$ironment ( )anitation
Contamination o! drin#ing water Contamination o! !ood .oss o! general immunity Breeding and increased density o! insects and
rodents Breeding o! vectors Spread o! water orne diseases ie c"olera,
enteric !ever
Spread o! vector orne diseases ie malaria,dengue Spread o! uncommon ;oonotic diseases due to
ecological disturances ie plague, leptospirosis
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Priority #n$ironmental &ealt )er$ices
Ade3uate amount o! sa!e drin#ing water Disposal o! "uman e$creta Disposal o! waste water and solid waste Ade3uate s"elter 'ood protection measures Gector control measures Promoting personal "ygiene and EC Disposal o! dead odies
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#n$ironmental &ealt and Priorities for
inter$ention in Emergencies
To recognise
To understand
To understand
To design
To descrie To identi!y
t"e environmental "ealt" ris# !actors
and constraints o! environmental
"ealt" management t"e asis !unction o! a sanitation
programme t"e value o! various water sources and
minimum standards !or water 3uality
and 3uantity a simple environmental "ealt"
programme diarr"oeal outrea# control strategies #ey indicators !or monitoring
environmental "ealt" programmes
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• Water stagnation
• Blockage of drains
• Inadequate H.P.• Water quality/availability• Irregular tank filling
• Lack of Ventilation• Inadequate Bathroo• !vercro"ding
• #olid "aste dis$osal.• %ly & osquito nuisance
• %ish "aste• 'ry fish sell
• 'efecation near the shelters.
• Inadequate sanitary facilities
• Poor use/ aintenance
Problems identified after te rapid en$ironmental
need assessment in Tsunami affected areas
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4se .ocally availale trained manpower asEnvironmental -ealt" Specialist are not
always availale Restore Pre
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)afe "rinking *ater)upply
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"iseases related to drinking +ater
contaminated +it micro,organisms
Diarr"oeaH
Typ"oidH
-epatitisH
C"oleraH
( Contaminated water is not the only cause of these diseases water
!uantity, poor sanitation and poor hygiene practices also play a role
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'eneral Principles of #mergency
*ater Management
All People s"ould "ave access to su!!icient 3uantity o! water!or drin#ing, coo#ing and personal and domestic "ygiene
At least 7% liters o! water per person per day need to ecollected
T"ere is at least 7 water point per >%& people 'low at eac" water collection point is at least &7>% liters per
second
T"e ma$imum distance !rom any s"elter to t"e nearest waterpoint is %&& meters
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'eneral Principles of #mergency *ater
Management cont-
Ensure 3uality o! water to reduce t"e transmission o!disease
Evaluate potaility o! potential water sources y rapidsurvey
Assess t"e iological ris#s associated wit" water Determine t"e pattern o! sur!ace drainage, pro$imity to
local sewage system and potential !or c"emicalcontamination
Rapidity to convert a source into sa!e one is very important
Rapid environmental "ealt" remedies: repair o! sewagelines0parapet o! a well
! no local sources availale, resort to water distriutionsystem
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.ecklist for *AT#/ )A#T measures at ield
le$el
At t"esource
ater !or drin#ing need to e collected !rom
t"e cleanest possile source
! necessary, a distinction is made etween
water !or drin#ing and water !or ot"er uses,suc" as at"ing, laundry, watering animals
ater sources need to e protected !rom
!aecal contamination y !encing (to #eep
animals away+, and y sitting latrines or
de!ecation !ields at least 7& I away,depending on ground conditions
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Collection,
storage and
use o7 aterat household
level
=se o7
ater
ater is collected and stored in clean,
covered containers
ater is ta#en !rom t"e storage container
wit" a clean, long
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Metods of making "rinking +ater )afe
Straining> ncase "eavy sediment or !loating matter present watermust e strained t"roug" several layers o! clean clot"es e!ore!urt"er processing+
&isin7ection>
Solar &isin7ection>
&isin7ection by Boiling > Boiling vigorously !or 7& minutesma#es water sa!e !rom "arm!ul acterial contamination ut it isvery di!!icult to searc" !uel !or oiling immediately a!ter adisaster
&isin7ection using Chlorine > C"lorination, t"e most commonmet"od in emergency
Disinfection should not be used as a substitute for protecting water sourcesfrom contamination.
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"omestic .lorination of "rinking *ater
Crus" commercially availale c"lorine& litres o! water
Allow to stand !or 6& minutes
4se water wit"in >@ "ours
Containers with a narrow mouth are recommended for the storage of
drinking water
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.lorination .ecklist
T"e optimum c"lorine residual in a small, communal water supply is
in t"e range o! &6 to &% mg0l
C"lorine needs at least "al! an "our contact time wit" water to
disin!ect it ever add any solid !orm o! c"lorine directly to a water supply, as it
will not mi$ and dissolve Always ma#e up as a paste !irst, mi$ing
t"e c"lorine compound wit" a little water
Disin!ection is only one de!ense against disease Every e!!ort
s"ould e made to protect water sources !rom contamination, andto prevent suse3uent contamination during collection and storage
T"e c"lorine dose re3uired to disin!ect a supply will increase i! t"e
water is very turid n suc" circumstances, it is est to treat t"e
water to reduce turidity e!ore c"lorination
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Pro$ision of )afe *ater )upply
Drin#ing water sac"ets may e
provided during initial p"ase
later water may e provided y
water tan#ers
Temporary small water tan#s
may e provided in t"e camps
Ade3uate c"lorination o! water
ensured y t"e "ealt" wor#ers
ater Juality /onitoring done
y testing !or residual c"lorine
and microiological testing o!
samples
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Tree .ommon Tests
'ield < ->S Test
.a< /ultiple < Tue 'ermentation Test (/P met"od
!or coli!orm acteria+
=T Test
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.ocation o! stand postover"ead tan#s
/et"od o! testingp"ysical, c"emical and
acteriological c"aracteristics
Periodicity o! testing
Resultsc"lorine level
Distriution area /ode o! distriution=-T, =-T and
pipes, lorries, R= system
Jualitydate o! testing
TDS
Bacteriological content Remedial actionc"lorination
"et"er end
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)afe "isposal of &uman#creta
A . kli t f A ti t i ld
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A .ecklists for Action at ield
Le$el
#3./#TA "I)P4)AL
4se o!designatedplaces !orde!ecation
Actions ta.en
De!ecation is avoided near water sources and
water
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A .ecklists for Action at ield
Le$el
#3./#TA "I)P4)AL(contd.)
C"ildrenMssanitation
Actions ta.en 4ncontrolled de!ecation y c"ildren is stopped
(T"e !eces o! young c"ildren are more "arm!ult"an t"ose o! adults+
T"e stools o! young c"ildren or aies are
wrapped in leaves or paper and uried or put in a
latrine
oung c"ildren are "elped to de!ecate into an
easily
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)ome Tips for safe )anitation issues
"uring "isaster
Sanitation Temporary latrines s"ould e constructed .ime to e used in communal trenc"es Area to e #ept clean aste water !rom t"e area to e properly drained
out
Sa7e distance o7 atrines ) metres !rom dwellings 6& metres !rom community well S"ould not e located at "ig"er level t"an
drin#ing water source S"ould not touc" t"e water tale
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)anitary Toilets
Development o! t"ree designso! t"e community level toiletsand inculcate t"e "ait o! usingt"em
ncineratora way to promotetoilet "aits among women anddisposal o! sanitary nap#ins
Development o! ay
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)trategies to .ontrol &uman #creta
"isposal at "isaster sites
Designate speci!ic areas !orde!ecation
Protect latrines !rom sur!acewater drainage
Consider cultural !actors inlatrine design (eg, need !orprivacy+
Educate t"e population
Ensure proper latrine
maintenance 'acilitate t"e population)s
access to latrines
-and as"ing wit" soap
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Maintaining a )anitation )ystem for
&uman #creta
Populations are unli#ely to use latrines o! t"ese are not#ept clean
/ay re3uire contracting out * t"e cleanliness service
Regular addition o! soil, diesel or as" to t"e latrines
Ade3uate source o! lig"ting !or nig"t use
Proper ad2ustment in si;e to !acilitate t"e use y c"ildren
Periodic inspection y "ealt" aut"orities is essential
Relie! agencies01=s may provide tec"nical assistance int"e !orm o! sanitarians !or construction, maintenance !orsupply o! dis
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Personal &ygiene and I#.
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A .ecklists for Action at ield Le$el
PERSONAL HYGIENE
ater !orwas"ing
Actions ta.en
! possile, plenty o! water is used!or was"ing
Clot"ing is laundered regularly T"e most readily availale water is
used !or personal and domestic"ygiene
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A .ecklists for Action at ield Le$el
PERSONAL HYGIENE
-and<was"ing
Actions ta.en
All !amily memers was" t"eir "andsregularly: a!ter de!ecating a!tercleaning a c"ild w"o "as de!ecatedand disposing o! t"e stool e!orepreparing !ood e!ore eatinge!ore !eeding a c"ild
Adults or older c"ildren was" t"e"ands o! young c"ildren
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)ome Tips .oncerning Personal &ygiene
"uring "isaster
(ersonal +ygiene
-and was"ing, cleaning and at"ing !acilities
Ade3uate water supply
Avoid overcrowding in sleeping area
.aunc" education campaign on personal "ygiene
I f i #d i d
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Information5 #ducation and
.ommunication
Based on t"e rapid environmental
assessment, target
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Information5 #ducation and
.ommunication cont-
As in sanitation, local pro!essionals are t"e people
w"o are est suited to develop and deliver
"ygiene education
Educational messages s"ould e s"ort and!ocused
T"e s"ould also !ocus on e"aviors t"at are not
eing practiced y a signi!icant !raction o! t"e
population
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)olid *aste and *aste *ater
"isposal
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A .ecklists for Action at ield Le$el
on )olid +aste "I)P4)AL
Solid aste
Actions ta.en
Re!use is not to e scattered aout (T"isencourages insect reeding and attracts rats
w"ic" can e a nuisance and transmit disease+
n t"e immediate post
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A .ecklists for Action at ield Le$el
on )olid +aste "I)P4)AL
Solid aste management
Sanitary disposal o! re!use to control vector<
orne diseases Burying or urning is recommended
Carcasses waiting urial s"ould e sprin#led wit"#erosene
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)olid *aste Management A continuous "ealt" education
programme need to e conducted onsolid waste management and t"eimportance o! vector control
"erever necessary, t"e stagnated
solid waste needs to e removedwit" t"e "elp o! local 1=s,community volunteers and sanitarywor#ers
A system in coordination wit" t"e
"ealt" aut"ority, sanitary wor#ers,1=s and community volunteers tomaintain solid wastage disposal ycollection, segregation andtransportation !rom t"e s"elterareas, need to e developed
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*ater "isposal Li6uid *aste
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A .ecklists for Action at ield Le$el
on WASTE DISPOSAL
Disposal.i3uidaste
Actions ta.en
Standing pools o! polluted wastewater (!romwas"ing, !ood preparation, wasted tapwater+ are not to e allowed to !orm (T"eyencourage mos3uito reeding, w"ic" is a"ealt" "a;ard+
C"ildren need to e prevented !rom playingin or near "a;ardous pools o! water
Arrangements !or disposing o! li3uid waste,
suc" as using soa#age pits, are understoodand !ollowed
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*aste+ater Management
Community moili;ation andeducation y sanitarianst"roug" demonstrations o!water disposal systems
n s"elters and villages, t"edrainage system need to eimproved scienti!ically incollaoration wit" t"e local1=s and governmentaut"orities
o stagnation o! waste water o water accumulation around
"andpumps,wells orstandpoints
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ector .ontrol
A . kli f A i i ld L l
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A .ecklists for Action at ield Le$el
VECTOR CONTROL
Personalprotectionagainstdiseasevectors
Actions ta.en -ouse"old re!use is removed regularly to avoid
uild
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)ome Tips .oncerning Management for
arious #& Issues "uring "isaster
?ector Control
Resume collection and sanitary
disposal o! waste
Conduct pulic education campaign
Survey potential mos3uito, rodentand ot"er vector reeding sites
Eliminate vector reeding sites
Resume indoor and outdoor spraying
Store !ood in enclosed and protected
area Keep watc" on environmental
sanitation and personal "ygiene
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ector .ontrol
Breeding places identi!ied and
control measures
Training programme organi;ed !or
t"e local community and 1=s !or
vector control in t"e s"elters Training t"roug" demonstration in
t"eir dwelling places would
motivate t"e community to aim !or
!ly
s"elters
Activities suc" as application o!
c"emicals, spraying, oil alls, sand
!illing and levelling activities wit"
community participation
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ector control measures
N 'ogging
N nsecticide spray
N Anti
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#stablis .ommunicable "isease
)ur$eillance
/ost important to get reliale in!ormation, avoidrumours
Reliale in!ormation reassures pulic aout t"e
disease incidence Surveillance to e led y one agency
S"ould e lin#ed wit" response mec"anism
Availaility o! consensus national tec"nical
guidelines
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)elter
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/elief camp
NCamp cleanliness
N'ood availaility
Nater and Toiletsprovided
.onsiderations for setting up
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.onsiderations for setting up
)elters
.ocation: close to road, drainage good /aintain !amily0clan identity Special consideration to t"e needs o! elderly disaled /onitor y Pulic -ealt" Surveillance
Determine t"e source o! sa!e waters Ensure sa!e disposal o! "uman e$creta /inimi;e overcrowding Proper drainage system
Pysical Issues Associated +it
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Pysical Issues Associated +it
)elter Management
Provision o! roo! I plastic s"ed Tents0Pre
metre o! temporary s"edding 1round s"eets0lan#ets0source o! "eating or cooling
A . kli t f A ti t i ld L l
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A .ecklists for Action at ield Le$el
SHELTER
At t"edisastersite
Actions ta.en
"ere people are trying to "ouset"emselves in t"e ruins o! t"eirprevious "omes, t"ey ta#e steps toavoid ris#s !rom t"e lac# o!structural integrity o! t"eir uildings
! t"eir "omes are de!initely unsa!e,people move
A .ecklists for Action at ield Le el
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A .ecklists for Action at ield Le$el
SHELTER
n longer<termemergency
settlements
Actions ta.en
People ta#e part in residentsMcommittees to voice t"eir viewsaout t"e setting up and running o! a
camp Residents participate in cleaning t"e
settlement
C"ildren do not enter dangerous
areas o! t"e settlement and, i!necessary, volunteers guard unsa!eareas
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ood )afety
)ome Tips .oncerning Management for
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)ome Tips .oncerning Management for
arious #& Issues "uring "isaster
Food Sa7ety
Kitc"en sanitation I most important 4tensils cleaned daily
Personal "ygiene maintained
'ood storage I precautions against rodents and
insects
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/ules for )afe ood Preparation
Coo# raw !oods t"oroug"ly
Eat coo#ed !oods immediately
Store coo#ed !oods care!ully
Re"eat coo#ed !oods t"oroug"ly As !ar as possile provide "ot !ood
Avoid contact etween raw !oods and coo#ed!oods
C"oose !oods processed !or sa!ety as" "ands repeatedly
Keep all #itc"en sur!ace clean
4se sa!e water
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"o you prepare food safety8
Coo#ing #ills germs T"oroug"ly coo# all meats, !is", and vegetales Eat t"em w"ile t"ey are "ot
as"ing protects !rom water
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Disposal of Dead Bodies in
Emergencies
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Mortuary Services
t is important to provide secure mortuary !acilities i! urialor cremation are li#ely to e delayed
A temporary mortuary site s"ould consist o! a reception, aviewing room, a storage c"amer !or odies not suitale !orviewing and a room to store personal possessions and
records Bodies s"ould e stored at @&C, alt"oug" t"is is rarely
possile /ortuary sta!! s"ould wear gloves and protective clot"ing
and s"ould was" wit" disin!ectant soap
T"e minimum !acilities are stretc"ers, leat"er gloves,ruer gloves, overalls, oots, caps, soap, disin!ectants andcotton clot"
To close a temporary mortuary, appropriate cleansing o!t"e site s"ould ta#e place
B d Di l
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Body Disposal
Burials in common graves and mass cremation are rarelywarranted and s"ould e avoided Burial is t"e pre!erred met"od o! ody disposal in emergency
situations unless t"ere are cultural and religiousoservances w"ic" pro"iit it
T"e location o! graveyards s"ould e agreed wit" t"ecommunity and attention s"ould e given to groundconditions
An areas o! at least 7%&& m> 0 7&&&& population is re3uired T"e urial site can e divided to accommodate di!!erent
religious groups i! necessary
Burial dept" s"ould e at least 7% m aove t"e groundwatertale, wit" at least a 7 m covering o! soil
Burial in individual graves is pre!erred Burial procedures s"ould e consistent wit" t"e usual
practices o! t"e community concerned
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8/13/2019 EH Measures for Disease Control After Emergencies
70/71
Publications
Re!erence: "ttp:00wwww"oindiaorg0E0Section660Section6@O7)@)"tm
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8/13/2019 EH Measures for Disease Control After Emergencies
71/71
T-AKS