For a community hit by a Category 5 hurricane, time gets divided in two: There’s before the storm…and after.
“An event like Dorian will provide a kind of historical marker in Bahamian history,” said Anthony Oliver-Smith, a professor emeritus at the University of Florida who studies societies before and after large-scale disasters.
After enduring multiple days of shrieking wind and pounding rain as Dorian paused overhead, the Bahamas – 700 islands which form a nation covering over 100,000 square miles of the Atlantic Ocean – are just beginning to put together a picture of the damage.
A Sense of Scale
The death toll currently stands at 20, although that’s expected to increase significantly. And although the worst of the damage was largely concentrated on the Abaco Islands and Grand Bahama, in the north of the country, those islands were hit with cataclysmic force.
According to the country’s prime minister, 60% of homes were destroyed in some places. It’s estimated that at least 60,000 people will require food and medical assistance. Hospitals on both the Abacos and Grand Bahama were affected, compromising access to vital medical care and forcing some patients to evacuate mid-hurricane.
“Disasters are difficult enough to contend with,” said Tricia Wachtendorf, a professor of sociology and head of the Disaster Research Center at the University of Delaware. “The impact to the Bahamas is really catastrophic in nature.”
What’s the difference between a disaster and a catastrophe? Wachtendorf explained that while the results of a disaster are more contained and localized – allowing nearby communities to help, emergency shelters to function, and so forth – a catastrophe “involves destruction to most or all of the built environment.”
In the case of the Abaco Islands and Grand Bahama, the built environment is so destroyed that it’s difficult to even get aid where it’s needed. A Direct Relief staff member delivering medicines and supplies had to take a route that was indirect and uncertain at best to reach the Abacos.
And while right now, efforts are concentrated on getting food, water, and medical aid to those most affected by Dorian, the experts consulted for this article all agreed that a storm of this magnitude has impacts that will likely continue for months or years afterward.
UBS, a financial services company, has estimated that Dorian will cost insurers up to $25 billion – a number that includes losses in the United States as well as the Bahamas.
But some of the storm’s damage – to communities and their health – may be harder to measure.
Damaged Buildings, Fragmented Communities
For one thing, Oliver-Smith said, a disaster can weaken, not strengthen, social bonds over time. “A community in the aftermath of a disaster will very often come together, but a disaster will also reveal some of the schisms within a community,” he said.
While in the short term, neighbors, friends, and families tend to be generous with resources and supports, “when reconstruction starts, there may be conflicts, and these are not easily resolved.”
In addition, Oliver-Smith explained, long-term displacement can create feelings of isolation, disorientation, and loss of identity that can lead to almost physical symptoms. People who have spent their lives occupying a certain job or social role may have to begin anew, in a new community.
“If you lose that [identity], who do you become? Who are you? You have to figure out who you are,” Oliver-Smith said.
The pragmatic aspects of recovery can be detrimental as well, Wachtendorf explained. “Stress associated with the protracted recovery process,” such as filling in endless forms or going into debt while waiting to be reimbursed, “can have very serious stress effects, sometimes more so than what they experienced during the event itself.”
According to Wachtendorf, a disaster can even affect educational attainment, as students are separated from friends, teachers, and established routines.
For Healthcare, Stormy Waters
In the days and weeks after a cataclysmic event, a familiar narrative emerges. People who have chronic conditions often find their care interrupted. Dialysis patients and others who rely on medical devices can find themselves in serious jeopardy if power or clean water aren’t available.
And displaced people are at particular risk for infectious disease outbreaks, which can range from pneumonia to meningitis. Unsanitary conditions and lack of access to clean water can cause cholera and E. coli outbreaks, among other threats. Since hurricanes tend to leave a lot of standing water behind, mosquito-borne diseases are a serious threat, especially in warm climates.
But on top of these frequent occurrences, the Bahamas will have particular health challenges of their own, said Dr. Warren Jones, the chief health officer at Hampton University, who has studied public health in the Caribbean.
Depending on where in the country a patient lives, they can go from “state-of-the-art care on Grand Bahama to having no care on some of the 700 islands,” Dr. Jones said. “When you get an interruption in the delivery of care…it really challenges the ability to get the right care at the right time for the people who need it.”
Some of the hospitals on the worst-affected islands are currently out of commission. “That means that for individuals with significant injuries, broken bones, people needing major surgery, those things are not available when the hospitals are not there,” Dr. Jones said.
According to Dr. Jones, the Bahamas have a high incidence of chronic disease – as is the case worldwide – and have the second-highest rates of HIV and AIDS in the Caribbean. For those populations, Dorian could have a years-long impact.
“When there’s devastation of this extent, you’re talking a minimum of two years before being able to provide sustainable, on-location care for the persons affected,” Dr. Jones said.
Even the limitations on clean food and water have the potential to harm patients with chronic disease, he explained. “When you get into situations where you have lack of access to appropriate foods and potable water, that complicates it even more.”
But it was post-traumatic stress disorder – shown to be extremely common after disasters – that Dr. Jones saw as being hardest to eradicate. “This will have a multi-decade effect,” he said.
Charting a New Course
What can be done to mitigate the damage to society and health?
“A lot of people are saying right now that we need to hurry up and help…but we don’t even really know if there’s a mechanism to distribute help. We don’t know if there are places to receive help,” Dr. Jones said. “When you’re in rescue and recovery mode, most non-indigenous help isn’t really set up to respond.”
To provide effective aid – and to make sure it’s culturally appropriate – Dr. Jones suggested working closely with people familiar with the needs of the affected communities.
Wachtendorf concurred. It’s not just that more targeted aid is better, she said. It’s that inappropriate donations can clog up distribution chains and take up vital resources, creating a so-called “second disaster.”
After Superstorm Sandy, Wachtendorf recalled seeing piles of clothing and other inappropriate donations piled up on the street. “Sitting in the middle of all of that was an ambulance that had been flooded.” If everyone who sent goods had contributed toward a new ambulance, she said, that would have been of much greater value to the community.
It’s easy to focus on disaster response – and to lose interest after the most immediate dangers have passed – Wachtendorf said.
But investing in a community’s long-term future – by contributing to daycares, community centers, and healthcare organizations – lets people “return to normal community functioning” over the long term, she said.
Direct Relief has provided medications and supplies to the Bahamas’ government and to medical teams responding on the ground. An additional 22 pallets of vital medicines and equipment, valued at $400,000, is poised to leave the Direct Relief warehouse.
The organization has also made its inventory available to partners in communities impacted by the disaster.