Health Service Provision and Public Health

Following a major tsunami, serious damage or destruction may occur to hospital and medical centre buildings, equipment and ancillary facilities. Often too, ambulance stations and paramedical facilities can be adversely affected or lost.

		Stopped clock at Aonae, Okushiri Island, Japan following the 1993 Hokkaido Nansei-Oki tsunami.

There will be a direct cost involved in the reestablishment of these facilities. Direct insurance loss will be sustained in respect of claims for rebuilding and equipment loss. Indirect costs associated with tsunami impacts on the health sector might include the extra costs (e.g. spraying) of dealing with water vector-borne disease outbreaks following sea water inundation of freshwater bodies (e.g. bacterial infections, cholera, typhoid, dengue and malaria). For example, following a major sea surge flood on Haiti in 1963, 75,000 cases of malaria were reported in the five months after the disaster because of poor vector-borne disease control. Following the July 1998 Papua New Guinea tsunami, the potential health threat associated with disease outbreak at Sissano lagoon resulted in the closure and exclusion of the lagoon until April 1999. The closure of the lagoon occurred in spite of its importance for the fishing industry both in the provision of subsistence catches and as a source for small scale economic fishing activity.

After the Papua New Guinea tsunami of 1998 and the death of several thousand people, the problems of health and disease became so severe that the Papua New Guinea Government sealed off particular devastated areas from the public. Indeed, many bodies from the disaster have still not been recovered. This particular disaster can teach us an important lesson because geological studies have pointed to the fact that tsunami disasters of much greater magnitude may have taken place in prehistory.

The issue of health and disease in relation to tsunamis should not be underestimated.

Housing

Loss of or damage to housing stock and personal property may result in considerable insurance claims for compensation. Claims are likely to be made on both building and contents policies. Levels of destruction and loss will reflect the level of insurance cover, building design specifications, magnitude of tsunami event and preparedness measures.

Tourism

Many parts of the world depend heavily on the revenue derived from its tourist industry and all the associated support services. A large natural disaster which has a negative impact on tourism and the aspects of the natural environment which bring tourists to an area can have a serious impact on the economic viability of a region or country. This will vary from place to place and country depending on the relative proportion of tourist derived GDP and the size and breadth of a country's economic base. For example, the Caribbean island of Anguilla derived some 40% (US$51 million) of its GDP from tourism in 1994. Following a major hurricane (with associated sea surge flooding in September 1995), the direct costs of damage to the tourist sector (hotels, restaurants, beach facilities and shops) accounted for US$29.5 million (some 50% of the total damage costs). The subsequent calculated loss of tourist income because of the disaster was expected to result in a fall of Anguilla's GDP of 12% during 1995/1996. The impacts of a major tsunami in an area where tourism plays a significant role in the economy could be very severe. This will be especially so where the general public perceives there to be a high risk and where significant damage has been done to the natural environment (e.g. loss of sandy beaches, destruction of hotel and beach facilities).

Civil Unrest and Political Instability

It has been reported in some cases that following major natural disasters there is some element of social unrest and in more extreme cases, breakdown in law and order. In such situations, there will be indirect costs associated with the need to police business areas with extra police or military forces. Following the Turkey earthquake and tsunami of August 1999, the Turkish government had to deploy conscript soldiers to patrol unguarded shops and banks in the central business districts of numerous towns following episodes of looting and localised breakdowns of law and order.

In extreme cases it is possible that a combination of a disgruntled population, slow official response and rehabilitation, increased market prices, lack of basic social services, poor food and health provision, civil unrest and fear, may lead to the destabilisation of a national government. When governmental collapse takes place, inflation may rise, investment may fall and economic trade may suffer.

Litigation

In many parts of the world affected by natural disasters like earthquakes and tsunamis, national governments have legislated that built structures should be designed to withstand natural events of specific magnitudes. Unfortunately, in many countries (especially those in the developing world), these regulations are not adhered to by either the structural designers, planners, builders or those commissioning buildings for a variety of reasons. Where catastrophic failure of such structures occurs, the injured or relatives of the victims may be eligible to make financial claims against the construction and engineering companies. As such, litigation may be a considerable indirect cost of a major tsunami flood. Following catastrophic structural failure because of incorrect building design in the August 1999 Turkey earthquake and tsunami, considerable public anger has resulted in a cry for accountability and financial liability.