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Year : 2022  |  Volume : 3  |  Issue : 1  |  Page : 105-110

The spectrum of health hazards by a volcanic eruption and the need for an integrated approach to mental health and disaster preparedness


1 Department of Trauma, Anaesthesiology and Critical Care, Level III IFH MONUSCO, Goma, Democratic Republic of the Congo
2 Department of Psychiatry, Level III Hospital, Goma, Democratic Republic of the Congo

Date of Submission27-Sep-2021
Date of Decision20-Dec-2021
Date of Acceptance09-Feb-2022
Date of Web Publication28-Apr-2022

Correspondence Address:
Dr. Shibu Sasidharan
Department of Anaesthesia and Critical Care, Level III IFH MONUSCO, Goma
Democratic Republic of the Congo
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_91_21

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  Abstract 


Mt. Nyiragongo in Goma, DR Congo, exploded on 22 May 2022. In the Philippines, on 1 July 2021, the Taal volcano, considered a restive volcano, spewed a 0.62 mile-high plume of gas and steam into the air, cascading a mass evacuation. Without any prior warning, Goma and central Manila were in a state of emergency, not knowing what to expect and how to react. Volcanoes provide a conduit by which magma – the earth's molten rock, gases and water – may interact with human biological systems. The importance of effective pre-disaster planning cannot be over-emphasised in such situations. The article dwells on the volcanic phenomena, which can cause many health hazards during the eruption and in between eruptions. The vast majority of volcanogenic fatalities in the past few centuries have resulted from events at the proximity – such as pyroclastic density currents, lahars and suffocation or building/roof collapse from ash or debris – and also distal events, such as tsunamis, which may travel for hundreds of miles from the active site, and indirect consequences of eruptions, such as famine or infectious disease outbreaks, including podoconiosis, fluorosis, geophagy, iodine deficiency disorders and rift valley fever. Although technology and geology can give a better lead time, predicting natural hazards and formulating, a plan in advance will obviously be very helpful for public health professionals. This paper is intended for health-care workers to understand the health problems faced due to a volcanic eruption, and this understanding, along with the recommendations given, will enable them to plan and prepare for the management of relief, rescue and medical care.

Keywords: Air pollution, disaster, emergency response, health effects, volcanic eruption


How to cite this article:
Sasidharan S, Dhillon HS. The spectrum of health hazards by a volcanic eruption and the need for an integrated approach to mental health and disaster preparedness. J Med Evid 2022;3:105-10

How to cite this URL:
Sasidharan S, Dhillon HS. The spectrum of health hazards by a volcanic eruption and the need for an integrated approach to mental health and disaster preparedness. J Med Evid [serial online] 2022 [cited 2022 Aug 12];3:105-10. Available from: http://www.journaljme.org/text.asp?2022/3/1/105/344303




  Introduction Top


The volcanic eruption of Mt. Nyiragongo in Goma, DR Congo, caught everyone off-guard as it exploded on 22 May 2021. When this 11,500-foot-high volcano erupted, it ended up killing at least 31 people the very same day [Figure 1]. It left lava streams pouring down towards the east in the direction of Rwanda. Another lava stream headed in the direction of Goma town and stopped 300 meters from Goma International Airport. The last major eruption (2002) resulted in over 250 deaths. Following the eruption, many of the local population evacuated during the night towards Saké, located 27 km west of Goma, and another group crossed the border into Rwanda seeking refuge. Cross-border movements into Uganda were less significant, and 90 per cent of Congolese have returned to the DRC. On 23 May, a helicopter reconnaissance mission with the Deputy Humanitarian Coordinator and an OCHA team confirmed that lava had blocked the main RN 2 Rutshuru-Goma road – the main supply line for food into Goma. Power lines and water supply have been damaged and cut-off to approximately 500,000 people. The lava destroyed three villages and one neighbourhood in the city of Goma on the DRC side. Thirteen civilians lost their lives during the night of 22 May due to evacuation-related incidents (primarily vehicle crashes). Civil society in the Nyiragongo health zone confirms that 24 people, 10 are women, were burned by lava, and 40 adults are missing. The identified remains were handed over to their respective families on 24 May 2021. Over 3,629 houses were ravaged by lava, 23 roofs of houses were blown away, the Goma-Rutshuru road was cut off (about 2 km invaded by lava) and three health structures, as well as three health structures well as 12 primary and secondary schools, were destroyed. UNICEF reported that more than 150 children were separated from their families, and more than 170 children are feared to be missing as people fled the city of Goma following the eruption of the Nyiragongo volcano. Earth tremors have been felt intermittently. The Rwandan seismic monitor recorded earthquakes reaching 5.1 magnitudes originating from Lake Kivu in the Rubavu district. These are causing cracks in buildings and placed further stress on an already traumatised population. Authorities warned the population to remain vigilant and remain out of the red zone, the lava path of the 2002 eruption. It is anticipated that ash emanating from the eruption may cause respiratory diseases.[1]
Figure 1: Series of images of Mt. Nyiragongo in Goma, DRC, before and after the eruption. (a) Mount Nyiragongo dominates the skyline of Goma. Note the plume from the volcano summit (Photograph taken in Jan 2021). (b) Mount Nyiragongo has the world's largest and most active lava lake. (Photograph taken in January 2021). (c) Mount Nyiragongo a few minutes before the explosion. (d) Lightning seen in Goma soon after the volcanic eruption. (e) Magma from Mt. Nyiragongo intruding to the nearby village on 22 May 2021. (f) Aerial view of the destruction caused by the eruption of Mt Nyiragongo in Goma. The volcanic debris emitted gases and vapours till five days after the eruption

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The two most active volcanoes of the Virunga range are Nyiragongo and Nyamuragira, which lie about 20 km apart. Mount Nyiragongo is situated on a highly active segment of the African Rift, favouring a quick ascent of magma from about 100 km beneath the earth's surface. Nyiragongo's lava lake has at times been the most voluminous known lava lake in recent history.[2] Its extreme fluidity and velocity make the lava impossible to escape. The last eruption before the present was on 17 January 2002, when Mt. Nyiragongo erupted at approximately 9:30 AM local time (2:30 AM EST).

On the other hand, Taal is one of the world's most miniature active volcanoes. Standing at the height of only 1020 feet, this small volcano, when it erupted in 1911, killed more than 1300 people.[3] Taal shot a column of ash and steam as high as 15 kilometres into the sky last January. This forced about 100,000 people to evacuate, leading to widespread flight cancellations and heavy ash falls in Manila.

Volcanic eruptions are preceded mainly by premonitory events that allow disaster planning teams to plan for the contingency. Volcanic eruptions, like an earthquake, leads to significant loss of life around the area of the explosion. Hence, it is essential to know what to expect in case of a volcanic eruption, have a plan in place for the eventuality of the possible disaster (medical and logistics) while simultaneously revisiting the updates given by geologists.

Unlike any other natural disaster, volcanic eruptions can cause a varied spectrum of health hazards. It can cause its effects at the volcano's proximity and thousands of kilometres away due to the dispersion of toxic gases and ash. It can also cause climate changes, and ripples impact a global level. Unfortunately, in many countries, the level of preparedness by the government and the local authorities are not adequate to ensure the safety of its residents. This paper is intended for health-care workers to understand the health problems faced due to a volcanic eruption, and this understanding will enable them to plan and prepare for the management of relief, rescue and medical care. The recommendations recorded in this article are applicable for both developing and affluent countries. The stress is on understanding the consequences of the catastrophe and preventive measures, not specific advice on medical treatment.


  Geology of Volcanoes Top


Volcano eruptions are classified into six different kinds: Icelandic, Hawaiian, Strombolian, Vulcanian, Pelean and Plinian. The explosive capacity of the volcanoes depends on at least 4 significant factors: the amount of gas dissolved in the magma, the viscosity of the magma, the rate of decompression of the magma as it rises toward the surface, and the number of nucleation sites on which the gases can begin to form bubbles.[4] The volcanoes from which the lava flows slow and little ash are produced cause lesser medical conditions (e.g., Silicosis), while with those causing catastrophic explosive eruption, the implications are worse. The type of activity can vary from eruption to eruption.


  Health Hazards Top


Volcanogenic fatalities/health hazards can happen because of various reasons. As human populations continue to grow and the volcano's proximity has increased, the risk also escalated. Volcanoes can be a health concern during as well as in between eruptions. In between eruptions, it can still emit harmful gases and cause phenomena such as debris avalanches, pyroclastic density currents (PDCs), volcanic mudflows and volcanogenic Tsunami, all of which are part of the volcanic phenomena. It can also destroy fertile land, intermittent small-scale eruptions, contamination of water supplies and air pollution –everything capable of affecting health.

Health hazards are classified as acute and chronic. The emergency measures that need to be undertaken should be classified as those near the volcano and those at a distance from the volcano.

Volcanic gases

Health hazards

The mortality ranges from 1% to 4%, attributable to volcanic gases. Mount Nyiragongo is presently the most significant source of sulphur and halogens.[5]

The volcanic gases consist of water vapour and other gases that react in the atmosphere to form aerosols, the most important being hydrochloric acid (HCl), sulphuric acid (H2SO4) and hydrofluoric acid (HF).[6] Most volcanic gases irritate the skin, eyes and mucosa (SO2, H2S, HCL, HF, H2SO4), while others cause inhalation injuries due to their caustic effect. Radon formed by the radioactive decay of uranium is a risk factor for lung cancer.

Recommendations

There is no mechanism to stop volcanoes from degassing. However, specific measures can be instituted to reduce the ill effects.

  1. Awareness –The local population usually has a reduced threat perception from a natural health hazard due to lack of awareness. They should be educated about limiting the exposure, using makeshift masks (e.g., wet cloth over the face), avoiding outdoor physical exertion and remaining on the windward side of the volcano in case of an eruption[7]
  2. Emergency warning systems should be in place to inform the local population in case of an impending eruption[8]
  3. Welfare measures – inhabitants around the volcano are likely to not return to their place of residence for weeks/months. Hence, a welfare fund to cater to their immediate requirements should be worked out
  4. Improved monitoring systems – the gases emanating (SO2, H28, CO2 and other gases) from volcanoes can be monitored by either direct sampling of fumaroles or remote sensing techniques[8]
  5. Search operation protocols and resources for finding the dead and missing people
  6. Locating emergency field morgues in the vulnerable area after a proper recce
  7. Training local population and communities on how to prepare for evacuation, actions to be taken and the routes for evacuation in an emergency. Training local hospitals to rehearse for the sudden influx of patients with varying injuries after a blast
  8. Artificial degassing if possible. These degassing pipes suction outgasses from the bottom to the lake's surface (e.g., Lake Nyos, Cameroon).


Geochemical diseases due to soil and water contamination in the African rift valley volcanoes

The volcanic eruptions lead to the upwelling of potentially harmful elements (PHEs) contaminating the soil and surface waters. The PHEs peculiar to African Rift Valley (ARV) volcanoes (including Mount Nyiragongo) are fluorine, iodine, arsenic, mercury, boron and lithium. The consequent trace elements imbalance leads to geochemical diseases characterised by either micronutrient deficiencies or excess of PHEs. The specific disorders of African rift valley volcanoes are podoconiosis, fluorosis, geophagy, iodine deficiency disorders (IDDs) and rift valley fever.

  1. Podoconiosis is a geochemical disease found in the distribution of alkali basaltic rocks of the African Rift Valley. It is caused due to prolonged (approximately 1 year) exposure of bare feet to Zirconium and Beryllium found in high concentrations in fine reddish-brown volcanic soils. Prolonged exposure to this highly abrasive soil induces granuloma formation in the lymphoid tissue of lower limbs. The clinical features are swelling and deformity of the legs associated with enlargement of the draining lymph nodes. The microscopic examination of nodes reveals bi-refringent particles.[9] The prevention strategy covers the feet with boots and avoids exposure directly to the soil
  2. Trace elements: There is a significant association between human and animal diseases due to trace elements imbalance caused after a volcanic eruption.


  1. Fluoride – Fluoride is required for optimal bone development and preventing tooth decay. However, when the concentration rises beyond 1.3 mg/L, it causes dental caries, mottled staining of the teeth, and fluorosis, i.e., malformed bone structure in humans.[10]
  2. Iodine – The leaching of iodine from the volcanic eruptions lead to reduced iodine availability causing IDD in African Rift Valley (ARV), most commonly Goitre[11]
  3. Mercury – Mercury is present in volcanic eruptions, fumarolic vapours and hot springs associated with volcanism. Mercury makes its way into the biological chain through contaminated fish from the lakes around volcanoes in the ARV. Mercury in its organic form (methyl mercury) gets easily absorbed from the intestines and skin and accumulates in the liver, kidney, and brain and even crosses the placental barrier into the foetus[12]
  4. Arsenic – Arsenic poses a major health hazard through contamination of drinking water with hot springs around the volcanoes in the ARV. Arsenic toxicity can predispose to skin, liver, and lung cancers.[13],[14]


Volcanic Tephra (Ash)

“Tephra” is the term for airborne fragmentary volcanic material emitted from volcanoes, while “ash” is restricted to materials <2 mm in grain size.[15] Hazards of tephra depend on the nature of the tephra. Tephra can cause silicosis and chronic obstructive pulmonary disease if inhaled. Tephra can also abrade skin and conjunctiva. It also has impacts on land and aquatic environments. Larger tephra can also destroy crops. When tephra carries volatiles gases from the volcano along with it (e. g., Fluorine), it can be consumed by animals and cause poisoning. The same contamination can happen with drinking water. A short-term decline in lung function and exacerbation of pre-existing lung conditions were seen in Mount St. Helen volcano's co-located inhabitants during its eruption in 1980.[8] In the British West Indies, exposed children (to ash) report a fourfold increase in wheeze and exercise-induced bronchospasm.[16]

Ash clouds can also damage jet engines and scrape cockpit windows.

Other volcanic phenomena

  1. PDCs: PDCs are hot gas and tephra clouds. PDCs can cause significant hazards to life with a dead: Injured ratio of 10:1.[17] PDCs usually form during the collapse of an explosive eruption column and are characterised by hot avalanches of rock, ash and gases and can travel at speeds of 350 km/hr or more with temperatures of several hundred degrees [Figure 1]e. Heat-induced shock, thermal lung injury, inhalational injuries, asphyxia due to ash plugs in airways and full-thickness burns are the major causes of death[18]
  2. Volcanic landslides: Because of their typical structure and its constitution (loose ash, rubbly lavas), volcanoes are prone to collapse. This is more due to the weakening action of acidic groundwaters. Earthquakes and heavy rains can trigger such events. Such landslides can happen much later after the earthquake can cause major health sequelae in populated areas like physical injuries, burial and buildings collapse
  3. Lahars: Volcanic mudflows or Lahars are a flowing mixture of rock and water that originates from the volcano's slopes. They can travel at a speed of 50 kms/h and can cross many kilometres, causing lacerations, penetrating wounds, eye injury, lacerations and infections as the most common hazards[17]
  4. Acid Rains: When rain falls through volcanic gas and emissions, it can become acidic. This can irritate the eyes and skin. It further causes effects on vegetation and water quality[19]
  5. Earthquakes: Earthquakes are frequently associated with volcanic activity. In Goma, frequent earthquakes rattled the city for more than 2 weeks in intensity after the volcanic eruptions to disrupt life and damage property. Earthquakes also predispose to Tsunami
  6. Global Climate change: Massive eruptions can cause acid aerosols into the stratosphere, blocking sunlight and accelerating ozone loss. It also affects crop yields and global cooling[20]
  7. Lightning: Volcanic ash clouds cause lightning, which can cause electrocution [Figure 1]d
  8. Tsunami: Tsunamis are caused when tidal waves from volcanic debris avalanches into oceans or lakes. Tsunamis can cause drowning and extensive property damage.[21]


Psychological aspects

There is a wide range (8.6%–57.3%) variation in the prevalence of psychological morbidity post-disaster. The psychological maladjustments after the disaster (Mount Nyiragongo eruption in 2002 and 2021) were reported as significant health consequences as per the WHO. After a disaster, the common psychiatric disorders are adjustment disorders, post-traumatic stress disorder, depression, anxiety disorders, psychosomatic symptoms and substance abuse. The worrisome mental responses to a disaster include abnormal/complicated grief reaction, which is severe and impedes the return of normal psychological and socio-occupational functioning.

The mental health preventive aspect is holistic and encompasses readiness (preparedness), response (instant action), relief (continued rescue work), rehabilitation, recovery (return to normalcy) and resilience (promoting). Mental health screening clinics should be established, especially for high-risk cases (e.g., Children, female gender, elderly, physically disabled, single, ethnic minority, displaced population, poverty, substance use like smoking, loss of economic livelihood). The relief workers in a disaster are exposed to considerable stress and run the risk of burnout, compassion fatigue and vicarious traumatisation. It is thus imperative to monitor their psychological status. The mental health professionals should train the local resources/disaster relief workers to deliver psychological first aid. They should screen high-risk survivors who pose a danger to self/others, disoriented to time/place/person, survivors with significant physical injury/death of a family member, history of mental illness, etc. After identification and ensuring the safety of the high-risk survivors, the relief workers, the relief workers should help them vent out and validate their emotions.[5] The environment and morale of survivors inside a relief camp are pensive and melancholic. A range of community-based interventions utilising the available resources with ingenuity can help provide a sense of control.

Specific occupational health hazards

Workers most prone to volcano hazards are volcanologists, geologists and staff of geothermal power plants. Construction workers, farmers and miners working in the volcano's vicinity can be exposed to fresh or ancient volcanic ash deposits, making them prone to asbestosis, silicosis and mesothelioma.[5] Inhalation of volcanic gases without protective respiratory gear can lead to irritant exposed asthma, including reactive airways dysfunction syndrome. Volcano tourists and documentary makers are also at risk.

Role of the preventive health team

The health team in charge of prevention has the following primary functions in a volcanic eruption:

  1. Collaborate with the other agencies (government, medical, information and humanitarian) involved in coordinating the disaster
  2. Field survey to collect data (dead, missing and surviving). Collaboration with fieldwork agencies for the same
  3. Assist field teams with evacuation and cater to the health needs of the affected communities
  4. Establish a health surveillance system.



  Everyone Has a Role Top


Prevention, meticulous planning and timely action during and immediately after a volcanic eruption are crucial to managing volcano-related morbidity. For the same, everybody has a role to play.

  1. Role of the volcano observatories: Scientists from the volcano observatories assess volcano hazards, develop volcano coordination plans, monitor volcanic activity, issue warnings of impending eruptions and deliver eruption updates through a formalised notification system
  2. Role of local governments and public officials: Public officials keep their communities safe by developing and exercising emergency plans and providing hazards education and notification about local hazards and emergency procedures. During the volcanic activity, they are the ones to advise residents about closures, evacuation routes and recommendations for recovery. Check our regional preparedness resources page
  3. Role of co-located individuals: Everyone can make it through a volcanic event with greater safety and less disruption by (1) learning about the hazards where they live or visit, (2) following local recommendations to ensure households and businesses are prepared and (3) preparing to be self-sufficient for up to 2 weeks by making an emergency plan and compiling an emergency kit. Some recommendations are:


  1. Pay attention to warnings, and obey instructions from local authorities. For example, stay indoors until local health officials tell you it is safe to go outside
  2. Listen to local news updates for information about air quality, drinking water and roads
  3. Turn off all heating and air conditioning units and fans, and close windows, doors, fireplace and woodstove dampers to help keep ash and gases from getting into your house
  4. Exposure to ash can harm your health, particularly the respiratory (breathing) tract. A disposable particulate respirator (also known as an “air purifying respirator”) may be considered to protect yourself while outdoors or clean up ash that has gotten indoors
  5. Stay away from ashfall areas, if possible. Avoid contact with ash as much as you can. Keep your skin covered to avoid irritation from contact with ash
  6. Wear goggles to protect your eyes from ash
  7. Do not travel unless you have to. Driving in ash is hazardous to your health and your car and will stir up more ash that can clog engines and stall vehicles
  8. Replace disposable furnace filters or clean permanent furnace filters frequently
  9. If you're drinking water with ash in it, use another source of drinking water, such as purchased bottled water, until your water can be tested
  10. Clear roofs of ash. Ash is very heavy and can cause buildings to collapse. Be very cautious when working on a roof. Ash can be slippery and make it easy to fall.


The above recommendations suggest that community resilience and recovery effects need to focus on nascent and early health problems that may signal the potential for more significant problems, reducing the ability of community members to help their areas recover. In addition to recovering their economic productivity, community members need to recover their health. Nutritional supplements to families and children, emotional support by allowing families to evacuate together and relocating families to environments similar to those from which they were evacuated are each strategies that can increase individuals' and families' abilities to participate effectively in community recovery through increasing their resilience. The idea should be to create innovative methods and models to combine insights from hazards research, geography and medical anthropology to suggest disaster plans for DRC and other places in the world with volcanoes.

To summarise, compared to many other natural disasters, volcanic eruptions allow scope for preventive action since they are a permanent natural feature, constantly reminding the dwellers of its risk. It is essential to understand that medical treatment has a very minimal role in the event of a major volcanic eruption. Nevertheless, preventive measures, use of technology, emergency planning and response can reduce injuries and loss of life. Most often, geologists can provide us with the information of an impending explosion, but even in its absence, high-risk zones should have the framework for care, tried and tested for use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Abstract
Introduction
Geology of Volcanoes
Health Hazards
Everyone Has a Role
References
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