Health Dimensions of Natural Disasters: Indonesia’s Mount Merapi Eruptions

Indonesia’s geographical location at the intersection of three of the world’s crustal plates makes it particularly prone to natural disasters.  Although Indonesia’s capacity to cope with natural disasters has been enhanced significantly since the 2004 Indian Ocean tsunami, aid workers still claim that the National Disaster Management Agency remains unprepared to cope with the health consequences of the recent Mount Merapi eruptions.

There are two dimensions of health that require consideration in this context. The first dimension of health in the context of the Mount Merapi eruptions relates to the direct and immediate physical consequences of the disaster itself. According to the World Health Organization (WHO), hot ash, gases, rock and magma cause burns, asphyxiation, conjunctivitis or corneal abrasion, and acute respiratory problems. Ashfall can also cause bronchial asthma and other chronic respiratory conditions in both children and adults. Additionally, inhalation of volcanic ash is a health security hazard because it can cause severe respiratory infections.

The second dimension of health within the aforementioned context is the emergency and humanitarian response dimension: the responses of health systems and aid to ensure the health security of vulnerable populations affected by natural disasters. Health risks after a natural disaster are dependent on size of affected/displaced population, proximity of and access to safe water and functioning latrines, nutritional status of the displaced population, vector control, levels of immunity against vaccine-preventable diseases such as measles, management of dead bodies, maternal and child health, public health surveillance systems, and access to healthcare services. Compounded, these problems can cause devastating consequences for the health of affected populations, as seen from Haiti’s post-earthquake cholera outbreak.

Existing response programs have taken these dimensions into account. Indonesia has a National Action Plan for Disaster Risk Reduction and an Emergency Preparedness and Response (EPR) Programme which outline strategic approaches to reducing human vulnerabilities  and health risks during disasters through a variety of measures. These include the establishment of regional crisis centres, increasing capacity building, and strengthening collaboration with the WHO. However, aid workers claim that at ground level, conditions in camps for those affected remain unsanitary, cramped and primed for serious health issues. These shortcomings could be partly due to Indonesia’s low health care expenditure in comparison with its neighbouring countries: Indonesia allocated 2.2 percent of GDP for the health sector in 2007, while the Southeast Asian average stood at 4.1 percent.

While comprehensive national plans and programmes are an integral aspect of health responses to natural disasters, they are best supplemented by similarly comprehensive and concerted efforts on the ground. Legal frameworks, accountability procedures, financial allocation, and organisational structures need to be supported by community plans for risk mitigation, local capacity for emergency provision of essential medical services, supplies, personnel and facilities, and early warning and surveillance systems. If Indonesia can achieve this necessitated level of coordination and facilitation, it will certainly be better equipped to mitigate the health security impact of potential natural disasters in the future.