The death toll in Turkey and Syria surpassed 25,000 people on Saturday as first responders from around the world continue in their attempts to save lives by finding and rescuing people trapped under collapsed structures. Local reports confirm that the earthquake, in addition to snow, has also interrupted logistical operations, including for emergency and healthcare needs.
While each disaster is unique, especially in terms of how they affect communities, general commonalities can be found.
“There is a huge spike in need for health service with all the injuries, a huge contraction of available health services as health facilities are wrecked, and inventories of medicines, devices, supplies are lost, and an information vacuum and breaking of the supply channels through which resources can be moved efficiently to address the huge gap that develops,” said Thomas Tighe, CEO of Direct Relief since 2000.
In sum, huge gaps immediately arise, and fewer resources are available to address them, a situation now playing out in Turkey and Syria, where at least 60,000 people are reported injured, and 15 hospitals in Turkey are reported destroyed, according to the World Health Organization. In northwestern Syria, at least 57 hospitals and primary health facilities were reported to be partially damaged or have suspended services due to the earthquake.
The answer would seem obvious — send more resources immediately. But it’s more complicated than that.
“Because supply channels get crimped, sending stuff that isn’t on-point just clogs up the channels,” Tighe said.
At the same time, minutes can be the difference between life and death in crisis situations.
“Waiting until the information is perfect doesn’t work because it’s a crisis and time is of the essence, and information will be fuzzy for a while,” he said, adding that sending the right supplies is also of paramount importance since mistakes can impair disaster response.
To solve this problem, Direct Relief tracks data from a range of past disaster response operations to find patterns – what medicines are requested most often for which emergency.
To anticipate what medicines and supplies will be requested, Direct Relief’s Head of Pharmacy, Alycia Clark, and her team start by considering what injuries are most common.
For earthquakes, she said, “crush injuries and wounds, combined with delayed access to care, will lead to more significant infections. Debris and particulates in the air will create new respiratory issues and exacerbate chronic ones. It will also contribute to eye irritation and injuries. Breaks in water supply and contaminated water can lead to gastrointestinal illness, which is layered on top of the existing cholera outbreaks. Many people will have cuts and abrasions and more severely injured patients will require surgeries for fractures and organ damage.”
Clark said that the response to the earthquakes in Turkey and Syria more closely resembles the war in Ukraine than a typical natural disaster response. This is due to the crush injuries from destroyed buildings and the unpredictable nature of events.
Needed medication will likely include antibiotics, IV fluids, medications to treat shock, respiratory inhalers and nebulizers, and medications for sedation and intubation for critically-ill patients and those requiring surgery, according to Clark. She and her colleagues confirm what is available in Direct Relief’s inventory and start trying to secure additional items and quantities through donations or purchases. Those include stains to diagnose corneal abrasions and ulcerations, numbing agents for pain, prescription antibiotics and steroid eye drops, psychiatric medications for mental trauma, surgical supplies, wound care, and body bags.
In some cases, this has resulted in prepacked “kits” for events with at least some degree of forewarning, such as hurricanes and wildfires. For others, such as earthquakes, drug and supply lists are maintained internally so that they can be quickly assembled when an event, like an earthquake or tornado, occurs.
As the response moves from the acute rescue phase to a more long-term operation in the coming days, Clark noted that priority will likely shift to chronic disease management medications since substantial amounts are likely to have been lost at hospitals, clinics, and pharmacies, as well as by individuals, who lost them in the ruins of their homes. The loss of power will also contribute to the decreased effectiveness of cold-chain medications, such as insulin.
“Many chronic diseases are considered “silent killers” because they actually do not cause any symptoms until they are out of control. For example, patients with hypertension may have no idea they have elevated blood pressure until they have a heart attack,” she said. it is easy to put off maintenance of these conditions because they don’t cause immediate discomfort. Doing so causes big issues,” Clark said.
Determining the appropriate quantities to send is the next step. Clark and her team follow the latest reported casualty figures and incorporate information directly from local doctors and pharmacists. They combine that data with baseline disease rates in Turkey and Syria to produce an estimated medication need.
The result is more than 70 pallets of medical aid – diabetes, asthma, and cardiovascular medications, dialysis supplies and medications for kidney disease, mental health medications and multivitamins — cleared to depart for Syria and Turkey within days of the earthquake.
Each item was reviewed and approved by the local medical professional who will ultimately receive it.
Still, despite the best preparation, both Tighe and Clark acknowledged disaster response operations always come with unexpected outcomes, which have to be accounted for in any modeling.
“We’re never fully ready,” said Clark. “But after Ukraine, we are a lot more prepared.”
“We have to make assumptions based on the best information available and move, knowing that the reality will overtake the assumptions and we’ll have to adjust accordingly, said Tighe.
