CHANDRA-Medical preparedness for natural disaster in India-ID1015-IDRC2014_b

5th International Disaster and Risk Conference IDRC 2014
‘Integrative Risk Management - The role of science, technology & practice‘ • 24-28 August 2014 • Davos • Switzerland
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MEDICAL PREPAREDNESS
FOR NATURAL DISASTER IN INDIA:
PERSPECTIVES & FUTURE MEASURES
CHANDRA Hem , PANDEY Ankita, SHARMA Sarika,
BHARDWAJ Nitin , MASIH Leela
Sanjay Gandhi Post Graduate Institute of Medical
Sciences, Lucknow, India

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CONDUCT PROTOCOL
• INTRODUCTION
• METHODOLOGY
• FINDINGS
• ENVIRONMENTAL ISSUES- MAN MADE?
• ADDED VALUE FOR THE POST 2015
FRAMEWORK FOR DISASTER RISK
REDUCTION
• CONCLUSION
• REFERENCES

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ASIA

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INDIA - Subcontinent

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INTRODUCTION
• INDIA is the seventh largest country in the
world .
• Total area of 3,166,414 square kilometres
(1,222,559 sq mil).
• India measures 3,214 km (1,997 mi) from
north to south and 2,933 km (1,822 mil) from
east to west.
• It has a land frontier of 15,200 km (9,445 mil)
and a coastline of 7,517 km (4,671 mil).
• The population is Approx. 1.25 billion
• Land - 90% ,Water – 10%

INTRODUCTION
INDIA is one of the most disaster-prone
countries in the world. Because of its diverse
bio-geographic regions and geological factors,
large parts of India are at greater risk of natural
hazards such as earthquakes, floods, cyclones,
droughts, landslides, and heat waves.
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India’s Vulnerability to Disasters
• 57% land is vulnerable to earthquakes. Of
these, 12% is vulnerable to severe earthquakes
ranging from magnitude of 1.7 to 9.3 on
Richter scale.
• 68% land is vulnerable to drought.
• 12% land is vulnerable to floods.
• 8% land (East Coast and Gujarat) is vulnerable
to cyclones.

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• Sub Himalayan area – Prone to landslide
• Apart from natural disasters, some cities in India
are also vulnerable to chemical and industrial
disasters and man-made disasters.
• The devastating nature of calamities in term of
human lives and national assets is not exactly
calculated but estimated.
• Super Cyclone (October 1999) caused more than
9,000 deaths.

• Bhuj earthquake (January 2001) resulted in 14,000 deaths.
• Tsunami (December 2004) accounted for the death of
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nearly 15,000 victims. In June 2013.
• Multi-day cloudburst centred on the North Indian state
of Uttarakhand caused devastating floods and landslides in
the country's worst natural disaster since the 2004 tsunami –
5700 deaths.

14,000
15,000
15,000
10,000
5,000
9,000
5,700
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0
Oct-99 Jan-01 Dec-04 Jun-13
Super Cyclone Bhuj earthquake Tsunami Multi-day cloudburst

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Uttarakhand

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Uttarakhand
• Uttarakhand has a total area of 53,484 km² of which
93% is mountainous and 64% is covered by forest.
• It is considered as one of the most beautiful states of
India.
• Uttarakhand is well known for Chota Char Dham:-
• Kedarnath,
• Badrinath,
• Gangotri and
• Yamunotri.
Main rivers-Alakhnanda, Mandakini, Bhagirathi, Ganga
and Yamuna.
It is well known as the "Land of the Gods"

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CHOTA CHAR DHAM
KEDARNATH TEMPLE BADRINATH TEMPLE
GANGOTRI TEMPLE YAMUNOTRI TEMPLE

* The race between tourism industries,
population growth, several hydroelectric
projects are in the fast track in
Uttarakhand districts.
* This region is seismically and
ecologically very sensitive and delicate
even a minute changes can create a
dangerous disaster.
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METHODOLOGY ( Sequence of disaster events)
• 14 to 17 June 2013 - Uttarakhand and adjoining areas
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observed heavy rainfall (375 percent more )
• Melting of Chorabari Glacier at the height of 3800
metres,
• Eruption of the Mandakini River, which ultimately led to
heavy floods near Gobindghat, Kedar Dome, Rudraprayag
district
• A multi- day cloudburst, centred on the state Uttarakhand
caused devastating floods and landslides also.
• Heavy rainfall for four consecutive days as well as
melting snow aggravated the floods.

• Himalayan Tsunami - A sudden gush of water engulfed the centuries-old
Kedarnath temple, and washed away everything in its vicinity
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and nearby area in a matter of minutes.
• 16 the June 2013 - flash floods taken a tremendous toll with an
estimated 200 villages affected and more than 5,700 citizens missing/
dead.
• severe destruction of property, including heritage and religious
structures.
• 18th June 2013 - Rescue operation including medical started .
• Mass cremation by Government agencies and priests of Kedarnath
temple after one week of tragedy.
• Resilience – After 11 months

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FINDINGS
Consequences –
Hindu Chardham (four sites) pilgrimage centers, are
visited by devotees, especially after the month of
May onwards. ( approx. 0.5 million/yr)
• Several houses were damaged due to massive
landslides and large flash floods and killed those who
were trapped.
• Entire villages and settlements such as Gaurikund and
the market town of Ram Bada, a transition point to
Kedarnath, was obliterated, while the market town of
Sonprayag suffered heavy damage and loss of lives.

* Over 70,000 people were stuck in various regions
because of damaged or blocked roads at more than 450
places.
* People in other important locations like the Valley of
flowers, Roopkund and the Sikh pilgrimage
centre Hemkund were stranded for more than three days.
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• An important artery connecting the region (National
Highway 58), was also washed away at many places.
• For more than three days, stranded pilgrims and tourists
were without rations or survived on little food.
•The roads were damaged at many places, resulting in huge
traffic jams, and the floods caused many cars and other
vehicles to be washed away.
* On 18 June, more than 12,000 pilgrims were stranded
at Badrinath, the popular pilgrimage center located on the
banks of the Alaknanda River.
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Assets destruction

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Submerged Structures

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Damage & Deaths

• Although the Kedarnath Temple ( the centre of
attraction & tsunami ) itself was not damaged, its
base was inundated with water, mud and boulders
from the landslide, damaging its perimeter.
• The temple was flooded with water resulting in
several deaths due to drowning and panic-driven
stampede.
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•Even after a week, dead bodies had not been
removed from Kedarnath town, resulting in water
contamination in the Kedarnath valley and villagers
suffered various types of health problems like fever,
diarrhoea.
•Rescuers at the Hindu pilgrimage town
of Haridwar on the river Ganga recovered bodies of
40 victims washed down by the flooded rivers as of
21 June 2013.
* Even as late as September, 2013, about 556 bodies
were found out of which 166 bodies were found in
highly decomposed state.
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Rescue Operation
Early Warning (EW)- Following Multitier, multi
agency natural disaster and flood EW systems
were activated on 18th June 2013 –
1. Geological Survey of India,
2. Defense Research Development Organization
3. Disaster Management Support ,
4. Indian Space Research Organization at state
and centre level.
These led to mobilize the agencies -

1. Indian Armed Forces –Operation Prahar
by central command, Army(Infantry, ASC,
Engineering, Medical corps ) , Indian Air
Force.
2. MHA- ITBP, BSF , National Disaster
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Response Force ( NDRF)
3. State Level- Police force, Home Guards,
Fire Police, PWD, Medical team.
4. Voluntary Organizations- Indian Red Cross
and others.

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Rescue Operation
• It was impossible for anyone to venture into the
Kedarnath valley beyond Gaurikund, by any means due
to adverse conditions. However, initial rescue works was
taken up in other areas.
• The seriousness of the situation was assessed early and
both the National Disaster Response Force (NDRF) and
the Indian Air Force (IAF) were requisitioned
immediately.
• Helicopters of IAF in fact reported in the afternoon of 17
June, 2013.

•Organized efforts by Indian Air Force and civil
choppers hired by the State Government, however, were
successful in reaching the Kedarnath valley only in the
early hours of 18 June 2013.
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• All available resources of the State Government
were at the same time immediately deployed for
relief and rescue work.
• Assistance of Para – Military Forces and Indian
Army was sought. Total of 110,000 pilgrims and
tourists were evacuated despite inhospitable terrain
and weather conditions.
• Indian Air Force carried out 2,616 sorties and
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evacuated around 21,961 persons.
• 2,000 sorties were undertaken by civilian
helicopters hired by the State Government to
evacuate the stranded persons.
• 12,000 persons were thus evacuated by civilian
choppers

•More than 5,000 vehicles were arranged by the
State Government and approximately 90,000 persons
were evacuated by road and boats.
•The State Government provided cash assistance so
that they can take care of their routine requirements
while in transit.
* Still the number of missing persons in all over the
affected region of Uttarakhand is estimated to be
more than five thousand.
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A big salute to the Indian Army and Police for their tireless service to those in
need.
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Relief operation

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Medical Relief
•Medical Relief started along with evacuation by
armed forces medical corps and secondly at the
destinations identified at different locations.
• Most of the patients were treated at local camps
organized by armed forces, Para military and disaster
task force.
• The patients required referral services were further
evacuated by chopper to district hospitals of hilly
terrain and Dehradun city.

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Medical Relief operation

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Aftermath
• INR 10 billion (US$170 million) relief by government of
India
• US$ 400.00 million contribution by states of India.
• USD $150,000 through the United States Agency for
International Development (USAID) immediate and
provide further financial aid of USD $75,000.
• Local people from affected villages stranded tourists and
pilgrims, by sending messages to their places and by
providing food.
• Rescuers also retrieved approximately 10
million (US$170,000) and other jewellery from local
persons.
• The estimated loss due to disaster was approx. 1000 mill. $

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MassCremation
Government agencies and priests of Kedarnath temple planned
mass cremation of the hundreds of victims, after one week of
tragedy.

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ENVIRONMEN
TAL ISSUES-Man
made
causes
Hydel power
plants
Tourism
Unlimited
building
construction
Deforestation

Other Causes:
• Growth of tourism
• Unchecked rapid increase of roads, hotels, shops and multi
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story housing in ecologically and fragile areas
• Failure of appropriate early warning communication system
• Lack of disaster management action plan particularly at
district and local levels,
• Lack of coordination and duplication of work among various
players and
• Political blame game
• Though it was a natural disaster, as per hazard typology, but
the impact was manifold due to human induced factors
couples with lack of mitigation and preparedness at various
levels

ADDED VALUE FOR THE POST 2015
FRAMEWORK FOR DISASTER RISK
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REDUCTION
Risk Reduction
• It is suggested that such areas should only be promoted
for tourism and do not for extensive urbanisation or a
platform of human dwellings
• It is also recommended that the hotels and other
buildings which are built in this area must have seismic
compatibility to ensure safety parameters.

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Risk Management
• Special task force units under the supervision of armed
forces to be developed and located for prehospital
evacuation from the place of occurrence in vulnerable areas
• Some establishment like First Referral Units (FRU) under
Armed Forces medical Corps to be established in different
locations of hilly terrain. The geographical terrain of the
area is such that only the army personnel have the required
training and capacity to overcome such natural adversity.
• The FRU should also help the upgradation of CHCs and
PHCs in that area for disaster preparedness and development
of disaster plan.

Risk Management
• The some of the district level hospitals to be upgraded
into tertiary level treatment centre and level one
trauma centre.
• Finally evacuation plan of victims from FRU/ PHC,
CHC to the nearest military/ district hospital to be
coordinated with surface and air transport.
• Adequate number of helipad may be made for air
evacuation of victims and this will also help in
transportation of food, medicine, clothes etc near the
place of disaster. Regular mocking exercise of relief
operation to be carried out on interval.
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New Directions for Disaster Management in India
•The National Disaster Management Authority
(NDMA) has been set up as the apex body for Disaster
Management in India, with the Prime Minister as its
Chairman.
* Disaster Management Authorities will be set up at
the State and District Levels to be headed by the Chief
Ministers and Collectors/ Zilla Parishad Chairmen
respectively.
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New Directions for Disaster Management in India
• A National Disaster Mitigation Fund will be
administered by NDMA. States and districts will
administer mitigation funds.
• A National Disaster Response Fund will be
administered by NDMA through the National
Executive Committee. States and Districts will
administer state Disaster Response Fund and Disaster
Response Fund respectively.
• 8 Battalions of National Disaster Response Force
(NDRF) are being trained and deployed with CSSR
and MFR equipments and tools in eight strategic
locations.
• A National Disaster Management Policy and National
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Disaster Response Plan will also be drawn up.

• Forests preserve biodiversity and prevent soil erosion –
vital for the local eco-system
•Hydropower and other development projects must not be
allowed without compensatory afforestation
• Environmental governance is one of the tools that offer
important opportunities for mainstreaming disaster risk
reduction and, thus, addressing the sustainable
development goals
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Forest & Environmental Preservation

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Resilience
The worship and tourism restarted
after 11 months

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CONCLUSION
• States can evolve pan-Himalayan strategy common
policies based on the region’s natural resources
forests, water, biodiversity, organic and specialty
foods, nature tourism – but without adverse effect to
the environment.
• Geographic location of Uttarakhand requires special
medical preparedness disaster plan .
• Medical preparedness for natural disaster to be
strengthened by establishing the FRU, tertiary level
treatment centre including level one trauma centre,
coordination with armed forces and evacuation plan.

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Lessons Learnt
• Be Prepared : Preparedness and Mitigation is
bound to yield more effective returns than
distributing relief after a disaster.
• Create a Culture of Preparedness and Prevention.
• Evolve a code of conduct for all stake-holders

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REFERENCES
1. Patra, Jyotiraj; Kantariya, Komal (2014). Science–policy interface for disaster risk
management in India: towards an enabling environment. Current Science, Vol.
(106) 20
2. A Critical Look at India’s Disaster Management: Lessons from the Uttarakhand
http://socialissuesindia.wordpress.com
3. "India raises flood death toll to 5,700 as all missing persons now presumed
dead”CBS News. 16 July 2013. Retrieved 16 July 2013.
4. Sharma, Manish; Mishra, Sunil, K.1; Tyagi, Shuchi (2013) The Impact of
Torrential Rainfall in Kedarnath, Uttarakhand, India during June, 2013.
International Research Journal of Environment Sciences ISSN 2319–1414. Vol.
2(9), 34-37
5. Conference Report (2013). Partnering for Rural Prosperity :Rebuilding
Uttarakhand with all stakeholders, OneWorld Foundation India, New Delhi
6. Business Standard. Retrieved 18 June 2013.

6. "Kedarnath temple stays intact, its surroundings have gone with
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flow". Hindustan Times. 18 June 2013. Retrieved 19 June 2013.
7. "Uttarakhand floods: Epidemic looms as people complain of fever,
diarrhoea". The Times of India. 26 June 2013. Retrieved 26 June 2013.
8. "Char Dham and Hemkund Sahib Yatra to restart from May
2014” IANS. News.biharprabha.com. Retrieved 24 April 2014.
9. Gupta, Anil K; Singh, Swati; Nair, Sreeja S (2014). Hydro
meteorological Hazards in Uttarakhand India, Himalaya - Forensic
Assessment of 2013 Flash Flood Disaster: Need of Integrated Planning
for Sustainable Development. International Journals of Geography and
Environment Sciences, Vol. 1(1), 9- 20
10. "India plans mass cremation for flood victims". Al Jazeera. 24 June
2013. Retrieved 24 June 2013.
11. Kumar, Amit (2013). Demystifying A Himalayan Tragedy: Study of
2013 Uttarakhand Disaster . Journal of Indian Research ,Vol.(1) 106-116
12. Kumar, Amit (2013). Demystifying A Himalayan Tragedy: Study of
2013 Uttarakhand Disaster . Journal of Indian Research ,Vol.(1) 106-116

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THANK YOU…

CHANDRA-Medical preparedness for natural disaster in India-ID1015-IDRC2014_b

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