From Paradise to Public Health Emergency

A ground-level view of the public health effort in the wake of Typhoon Haiyan

Published on November 20, 2013by Stephanie Lucas

The Philippines has endured its share of natural disasters. It encounters numerous earthquakes and around twenty typhoons per year. This year has been a particularly difficult one, from the Bohol earthquake just last month to typhoon Haiyan/Yolanda last week, it is heartbreaking to see how much the environment impacts the lives of so many people here. I have a little over a month left of my practicum in Manila, and this is a glimpse of what the last two weeks have been like for me.


The weekend before the typhoon hit, I was in Coron, a city in the province of Palawan, which people like to call the “last frontier of the Philippines.” I had spent the first two months of my global practicum living in Palawan, so it was natural for me to trade the fast-paced life in my current residence, Manila, for a weekend in paradise. On a boat ride there, a friend and I toured numerous limestone islands, hiked trails to swim in the famous Lake Kayangan, and climbed up Mt. Tapyas to view the large cross and gush at the view of Coron Town during sunset. It was magical. All of these sites would be severely devastated a mere four days after I left.

Lake Kayangan smaller

Lake Kayangan in Coron before the typhoon (Credit: Stephanie Lucas)

In retrospect, people living here seemed to realize the magnitude of the situation a few days before the storm hit when the news began to use such phrases as “super-typhoon” and “strongest storm in history to make landfall.”

On Thursday, IOM staff continuously received messages that matched particular regions in the Philippines to varying levels of storm signals, with Manila hovering between two and one (lower levels of severity). Our safety and security unit sent texts about how to make an emergency kit.  By that night, we heard of evacuations occurring in the Eastern Visayas regions. Most schools cancelled their Friday classes. Many of my coworkers planned to stay home the next day, and many others were going to leave early.

I heard reports of the typhoon hitting Samar and Leyte early Friday morning, but that was about the extent of the news. The storm was ravaging through the Philippines, and it was set to be closer to metro Manila by nightfall. The dark and ominous sky, however, looked scarier than it actually was. We only had about an hour of light rain and some winds here.  We were lucky: the typhoon nearly missed us entirely.

We couldn’t say the same for anywhere else, though. We knew this storm was a bad one, but there was no way to tell at the time the exact extent of devastation that it caused.

Post-typhoon: short-term

That weekend, reports slowly started to surface about the damages: the Eastern Visayas region where the storm initially made landfall was particularly hard hit. Other areas like Central Visayas, Southern Luzon and Northern Palawan were also said to be affected. Luckily there were places that were spared. Friends I knew in central Palawan said that they experienced heavy rains and wind, but that all in all, the informal communities that they worked in were ok.

On Monday, stories started to circulate in the office. People with family and friends in affected regions had much difficulty contacting them. A surgeon from Samar sent word that his town was not okay.  He appealed to my coworker for help, telling how many people were injured or missing and how many houses were flattened.

But at that point, it was still difficult for me to fully comprehend the situation. What I saw on the news and the stories I heard impacted me, but it wasn’t real yet. I was living in the Philippines. I was in Manila. People were still going to work and carrying on with their lives. I sympathized, but I did not fully get it.

Coron Town including the market (left) and Mt. Tapyas[1]

Coron before the typhoon (Credit: Stephanie Lucas)

Then I received word from a friend I made in Coron.

She reported that many trees had fallen causing places like Lake Kayangan–where I had been the weekend before–to be inaccessible. The large cross on Mt. Tapyas fell.  More than 50 boats were destroyed. Many people were dead or missing.

The devastation started to hit home.

On Tuesday, I participated in a series of health cluster meetings at the Philippine Department of Health, where the details of the storm and its destruction became even more concrete. I never thought about what actually goes on behind the scenes of a humanitarian response until that moment.  It helped me look beyond mere sympathy and realize that we, in being there, had the responsibility to do something. We discussed how to assess the situation, brought up current and potential challenges, and aimed to organize, prioritize, and coordinate response efforts. The details can be found can be found here in the situation report.

As someone who has no prior experience with disaster relief, I see now how difficult it can be for the people leading a response to weigh questions of necessity, efficiency, timeliness, and accuracy. With my epidemiology background, I am struck by the tension between collecting and analyzing data in a timely manner and simply acting with the information that you have. It takes collaboration with others, patience and composure to make tough calls that will save lives and restore structure to a seemingly hopeless situation. It takes negotiating the differing priorities of individuals and groups in order to come up with a solid plan of action. It takes the ability to recognize and utilize the human rights framework in a situation that stripped individuals of that dignity. To put it simply, it takes finding creative short and long-term solutions to both minor and major challenges.

In another blog post, I noted a handful of challenges that have impeded efforts to get relief to people who need it the most: difficulties in transportation, bad weather, security issues, poor infrastructure, and the need for increased coordination of efforts among the numerous organizations involved.  Yet there are many other immediate challenges: how do we manage the dead bodies in a way that is public health conscious and culturally appropriate?  What about other areas of lower priority that are still in need of help- like Iloilo, Caniz or Coron? The list can go on and on.

This is the context of post-typhoon Haiyan. The issues are both logistically and ethically difficult, but they are what we as future public health professionals are training to face.

Post-typhoon: long-term

The effects of catastrophes such as Typhoon Haiyan stretch way beyond the short-term relief needs. What will happen when the news coverage ends? Will funding and aid still continue? How do we rebuild whole cities and re-establish infrastructure once the rubble has been cleared? How do we ensure the continuity of care and access to care for the massive amounts of displaced people? This list, too, can go on and on.

I received a text today from my friend in Coron. While she is physically well, she has many other issues to deal with. Currently she is homeless. Her house was completely destroyed in the storm. She doesn’t have any money or a means of making any. As an island guide, the storm has halted all tourism almost completely, leaving Coron’s major industry to rapidly deteriorate. And all of this stress may unconsciously start to affect her mental health.

This is just one person in one town affected by Typhoon Haiyan. There are millions of others.

In public health we identify challenges that impede population health and try to find innovative ways to mitigate them, but it is not easy. Typhoon Haiyan shows us this.

coron after typhoon

Coron after the typhoon (Credit: Coron mayor’s office)

My experience within the last week has reinforced two very important ideas:

  1. The public health problems we will address are complex and interconnected- but they are not impossible. The post-typhoon response efforts have been coordinated among many groups that focus on various health issues: food and water security, shelter, access to care, reproductive health and maternal health, mental health,migration health, vaccinations, etc. It has required multidisciplinary teams that come up with innovative solutions to pressing problems. And despite all the criticism, I can tell you that there are people here that are actually coming up with solutions.  (You can keep up with up-to-date humanitarian aid efforts here.)
  2. Even with the current tools and protocols, there is always room for improvement. We still do not know the perfect way to address complex emergencies like Typhoon Haiyan (and maybe there will never be); sometimes these instances are just too sudden, too intricate, or too different contextually to apply the same solutions used in the past. But what we can do is try and learn from experience, improve the methods that we have, or come up with new and better ways to address the problems. This is exactly why public health people are needed.

Typhoon Haiyan is not going to be the last disaster or crisis. We need to continue  thinking about these issues before the next one comes.

I want to keep encouraging people to donate or at the very least, keep the Philippines in your thoughts. While there is still so much to do, Filipinos will get past this crisis- especially with all the help and support they are currently receiving.

Featured photo: Eoghan Rice – Trócaire / Caritas. Edited by Elaine Meyer