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Floods in Poland in 1997 and in Sweden 2000 – KAMEDO-report 76

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.

Summary

The European continent has in latter years regularly been hit by floods. In the summer of 1997 Poland experienced one the largest floods in the country's history. Water covered 10 per cent of the country and some three million people were affected. The floods occurred very rapidly which led to many people being injured and it is estimated that 55 people were killed. In Sweden it was first southern Norrland that was hit by large amounts of rain in the summer of 2000, and later in the autumn it was the west of Sweden, resulting in extensive flooding. The conditions concerning amounts of rain, geography, climate and infrastructure differed considerably from those in Poland and therefore the Swedish population was not affected as dramatically. No deaths or personal injuries were reported, nor was there any extra strain on the health service, whose buildings escaped damage.
In Poland control of contagious diseases and health protection worked very well in all essentials. Expected epidemics did not occur and the situation regarding epidemics in the flooded areas was compared to previous years even better than in those that were not flooded. It is judged that a range of factors contributed to things working so well and the most important were
• massive information about hygiene was given to the general public, in particular concerning drinking water, sensitive food and personal hygiene. The information was primarily provided via the radio
• the general public behaved in a disciplined manner and observed the instructions and advice of the authorities
• distribution of drinking water (bottles) and food was quickly arranged locally
• the National Institute of Hygiene had skilful management that centrally controlled the counties' sanitary-epidemiological stations/Footnot: Sw. sanitärepidemiologiska stationer/ out in the country. Any risk or outbreak of infectious diseases was reported daily
• there was healthy scepticism as to whether vaccination could solve the problems and therefore only high-risk groups were vaccinated.
In Sweden there were no reports of more than the normal number of cases of water-borne contagion, neither from South Norrland nor from West Sweden. The number of domestic cases of campylobacter infection in Sweden was lower in 2000 than in 1999. There was in the summer and autumn of 2000 an extensive epidemic of tularaemia in Sweden, which according to the Swedish Institute for Infectious Disease Control may be seen as a mosquito-borne disease and it was therefore thought that the increase could have been caused by the wet summer and the large number of mosquitoes.
During the floods in Poland it became very clear how dependent we are on a working water supply and the damage to the water and sewage system was very extensive and costly. The water works were located close to the river and the electricity supply was interrupted and untreated water was taken in, which contributed to their being put out of service. Restoration of the water supply was therefore given the highest priority but it still took a month before the main part of the city of Wroclaw again had its normal water supply. When water was again let in to the pipes, it was recommended that it was boiled for ten minutes instead of the usual one minute. Tap water is not normally drunk in Wroclaw unless it is boiled, which certainly contributed to limiting the number of infections during and after the flood. The habit of drinking bottled water in Poland was undoubtedly also of certain importance.
The floods caused problems with the water supply also in Sweden. Several municipal water works had problems with contaminated water but overcame these by chlorination, water distribution in tanks and by a directive to the effect that water should be boiled. Those in charge of the water supply worked hard at managing the municipality's water supply by constant monitoring, testing and damming/Sw. invallningar/. There was a considerable risk of contaminated surface water getting into the water supply sources. Many private wells were contaminated but the risk of infection was kept at a reasonably low level because of the warnings issued. Water was instead taken from safer wells and/or the water was boiled. One problem was that the water laboratory engaged could not cope with the pressure of work in the summer and the waiting time for analysis results was unacceptably long.
Sewage became a problem both in Poland and in Sweden. It was in the flat Polish landscape difficult to draw off the sewage, not least because of back flush of water through sewage pipes and river overflows/Footnot: I det flacka polska landskapet var det svårt att avleda avloppsvattnet inte minst då det i avloppsledningar och bräddavlopp till floder trycktes upp vatten i ledningarna bakvägen. I am uncertain of the exact meaning and the English technical terminology/. In Sweden it became necessary to discharge untreated waste water into the receptors and in spite of considerable dilution in watercourses and lakes it caused the quality of the bathing water to be impaired at certain beaches.
There was an avalanche of refuse in Poland because it was necessary to discard everything that had been water damaged. It was not possible to collect the refuse in the customary way, so it was stored in the open in large piles to be removed later. Rat control was implemented in the autumn and this may have contributed to there being no increase in leptospirosis, which can be spread by rats, in the period.
Compared with the Swedish health service, which was never affected by the floods, the Polish health service in the flooded areas had a number of problems:
• hospitals had to be closed because of the floods
• heavy equipment, e.g. CAT scanners and mainframe computers were destroyed by the water
• patients had to be moved to other hospitals
• otherwise functioning hospitals lost their electricity and water supply
Eleven of 198 hospitals in the flooded areas had to be evacuated. The evacuation and relocation of patients to other hospitals was solved by the Ministry of Health, which was in a position to make rearrangements within the state hospital care service. Poland experienced only a modest increase of persons seeking treatment at the hospitals but non-emergency cases were notwithstanding this not admitted for treatment, e.g. for elective surgery. The hospitals also requested pharmaceuticals from abroad, which led to large amounts of pharmaceuticals being received, which however caused problems rather than provided benefits.
The floods caused very considerable damage to the infrastructure of Poland. The cost has been estimated at 30-40 billion Swedish crowns. Roads, bridges, homes, industries, hospitals, waterworks, water purification plants and flood protection were destroyed. To this should be added extensive damage to the electricity, telecommunications, water and sewage networks. It is estimated that the work with restoring the damage caused by the floods will take at least ten years. Much of the destroyed property had inadequate or no insurance cover. The effects on the infrastructure of the regions in Sweden were more limited. It was primarily the railway and road networks that were damaged.
The emergency arrangements in municipalities and county councils appear to have been good in Sweden. The municipalities' emergency organizations had to bear the brunt of the burden, and this happened in several of the Norrland municipalities that were hit. Those in charge of water supply and environmental offices were attached to the management groups. The floods came in the middle of the holiday periods there and it was difficult to get hold of key persons and many had to interrupt their holidays.
The floods in Poland were so extensive that a national effort was needed. It was some time, however, before the government and the ministries understood the seriousness of the situation and began to take action. A crisis headquarters was established in the evening of 8 July 1997 after the city of Klodzko had been flooded through the torrential rain that had fallen since Saturday 5 July.
On 8 July a decision was made to request aid from other countries, at the same time as considerable rescue operations started, which in due course involved 35 000 men, 76 helicopters, 4 aircraft and 387 boats/amphibious craft. Military personnel and rescue services contributed to saving lives and to providing drinking water, food etc. Volunteers also participated to a large extent.
In many Polish municipalities and counties that were first hit by the flood they quickly realized that outside help was needed. When Warsaw initially decided to wait and see, this led to municipalities, counties, hospitals and aid organizations attempting to get help from abroad. This impaired the possibilities of co-ordinating foreign aid. The United Nations Department of Humanitarian Affairs (UNDHA) was however quickly on site and provided status reports, for instance via the Internet.
There was very a great need for outside aid. In the short term there was above all a need for money, rescue equipment, vaccine, mobile waterworks, mobile electricity plants, large pumps and certain expert support. Those in positions of responsibility in the affected regions are generally subjected to severe media pressure when disasters occur. In some places in Sweden meeting journalists became a full time occupation. Medical officers responsible for infectious disease protection, those in charge of water and sewage and environmental offices as rule managed to get their messages across via the media, which was valuable and perhaps crucial to preventing water-borne contagion.

Experience

• In Poland like in many other countries hit by natural disasters, authorities and vital institutions are often criticized for not acting in time. It is in all probability difficult to judge the extent of disasters, at the same time as people do not quite know how to act. Catastrophe plans and exercises are therefore important both at a national, regional and local level, and above all better criteria are needed for when they should be activated.
• It is crucial that one in flood risk areas builds up contingency arrangements to cope with shorter periods of isolation. The contingency arrangements should include above all independent supply of potable water and to some extent energy. When aid from other countries is needed, the request should come from the country's government or crisis headquarters. It is usually of great value to have aid requirements evaluated by observers from outside with experience of disaster medicine.
• Military personnel and volunteers were of great use in both countries. In Sweden also the Home Guard contributed with important efforts. The local contingency organizations ought to have better knowledge of what resources the armed forces can provide.
• The National Swedish Board of Health and Welfare and the Swedish National Food Administration earlier activities concerning contingency plans for health protection, control of infectious deceases and drinking water contributed to a good state of mental preparedness. Swedish exercises and plans for the millennium were also mentioned as having been positive. Some municipalities also had previous experience of extensive flooding and others had previously practised flood scenarios.
• It is crucial that all care institutions of importance have stand-by generators for electricity and water that are adequate for emergency operations for a few weeks.
• Radio communication is of great value when both the land and mobile telephone networks are overloaded and stop working. It may be the only possibility of directing rescue actions. The possibilities of conveying important messages to the general public via transistor radio should also be utilized in case of e.g. power cuts.
• Information to the general public concerning meticulous water and food hygiene is of the utmost importance in providing protection against infectious diseases. Vaccination protection need only be boosted for persons who do not have adequate basic protection, who are particularly sensitive to infection or who are exposed to more contagion than others.
• Supply of potable water is one of the most important initial measures in all types of disasters, also in case of floods. If there is uncertainty about the quality of the water, it should be boiled in order to avoid water-borne contagion.
• When disaster aid is requested from other countries, it can often be established that the aid requirements are presented differently to the picture you get after a couple of days' visit to the country. This applies for instance to the situation in Poland. It is therefore always necessary to make up your own mind about the kind of aid that should be offered.
• The floods were managed better than expected in Sweden. This may to some extent be explained by the landscape being very hilly in the flooded areas. Also, no dams burst and there were no lengthy power cuts. Contingency arrangements were moreover good in the regions, and a network of contacts hade been developed and exercises had been held. Early warning was also given of contaminated water.
• There should in future be recurring exercises and training for personnel within water and sewage, infectious disease control and environmental offices. Water laboratories need to improve their routines in order to be able to carry out water analysis more quickly.
• Location of new sources of water supply, untreated waste water pipes/Footnot: Sw. bräddavlopp/ and healthcare facilities should take into account the risk of flooding and landslide. In Sweden, the water regulation companies should also review the effects of their various strategies for drawing water/Footnot: Sw. tappningsstrategier/.

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