Impactos físicos e psicológicos na população de Brumadinho após rompimento da barragem de rejeitos / Physical and psychological impacts on the population of Brumadinho after rupture of the tailings dam

Objetivo: Esta revisão sistemática busca identificar os fatores que podem impactar na saúde das vítimas do rompimento da barragem, em especial aqueles riscos surgidos ou incrementados com a ruptura da barragem de rejeitos em Brumadinho. Fontes de Dados: Bases de dados informatizadas, Pubmed, Scopus e Web of Science nos idiomas Português e Inglês, restringindo-se a publicações nos últimos cinco anos. Critérios de inclusão: estudos que abordem aspectos relacionados à saúde dos envolvidos na ruptura da barragem de Brumadinho. Foram excluídos estudos que abordassem qualquer tema que escapasse desse escopo. Síntese dos Dados: Foram identificadas um total de 157 publicações. Excluíram-se 127 pelo título, por serem duplicatas e pelos critérios de exclusão. Analisou-se 30 integralmente, restando 19(63,3%). Resultados: Por meio dos critérios de elegibilidade dessa revisão foram encontrados artigos sobre as consequências do achado de metais pesados nas águas dos rios, como o favorecimento de genes multirresistentes e o comprometimento de fonte de água potável. Também foram descritos os impactos na saúde mental em Brumadinho, pois nota-se que a população está sujeita a efeitos psicológicos traumáticos secundários a desastres ambientais. Por meio dessa busca foi identificado que ainda há a necessidade de novos estudos sobre os impactos da mudança da morfologia hídrica e social para a saúde desses indivíduos. Conclusão:Alguns poucos impactos diretos e indiretos já estão descritos na literatura de forma incipiente, de forma que ações de mitigação são necessárias para dirimir os impactos já observados.

Abstract: This systematic review seeks to identify the factors that may impact on the health of the victims of the dam rupture, especially those risks arising or increased with the rupture of the tailings dam in Brumadinho. Data Sources: Computerized databases, Pubmed, Scopus and Web of Science in Portuguese and English, restricted to publications from the last five years. Inclusion criteria: studies that address aspects related to the health of those involved in the Brumadinho dam rupture. Studies that addressed any topic that fell outside this scope were excluded. Summary of Data: A total of 157 publications were identified. 127 were excluded by title, because they are duplicates and by exclusion criteria. 30 were analyzed in full and, of these, only 19 (63,3%) were eligible. Results: Through the eligibility criteria of this review, articles were found on the consequences of the finding of heavy metals in river waters, such as the favoring of multidrug-resistant genes and the impairment of drinking water sources. The impacts on mental health in Brumadinho were also described, it is noted that the population is subject to traumatic psychological effects secondary to environmental disasters. Through this search, it was identified that there is still a need for further studies on the impacts of changing water and social morphology on the health of these individuals. Conclusion: Direct and indirect impacts are shown and that actions are fundamental for their mitigation.

Efeitos tóxicos à saúde humana e ao ambiente causados pelo derramamento de rejeitos de minério da barragem de Fundão / Toxic effects to human health and the environment caused by the spillage of ore tailings from the Fundão dam

Objetivo: analisar as evidências científicas existentes até o presente momento que descrevem os efeitos tóxicos causados à saúde humana e ao ambiente, devido à liberação dos rejeitos de minério, decorrentes do rompimento da barragem de Fundão em Mariana - MG. Métodos: a revisão narrativa da literatura baseou-se na busca de artigos em quatro bases de dados: PubMed, SciELO, Science Direct e LILACS, utilizando os descritores "Dam", "Fundão" e "Mariana" junto com o operador booleano "AND". Resultados: trinta e quatro das oitenta e cinco publicações encontradas atenderam aos critérios de inclusão e foram utilizadas para compor a presente revisão. Foram observados os seguintes efeitos tóxicos: contaminação da água e do solo, principalmente, por metais pesados, potencial genotóxico, citotóxico e mutagênico da água, diminuição da diversidade microbiana, contaminação de peixes, perda da vegetação e prejuízos ao metabolismo de crescimento de plantas. Entre esses metais, foi relatado aumento na concentração de ferro, manganês, cobre, cádmio, chumbo, arsênio, cromo, magnésio, alumínio, mercúrio, cobalto, bário, níquel e selênio. Além disso, o desastre promoveu o aumento no número de casos de doenças humanas, como dengue, doenças respiratórias, dermatológicas, intestinais, psicológicas e comportamentais. Conclusão: todas as evidências científicas expostas na presente revisão sugerem que houve a contaminação ambiental, bem como da população local, por agentes tóxicos presentes nos rejeitos de minério, em especial metais pesados, liberados após o rompimento da barragem de Fundão. Assim, torna-se essencial a realização de mais estudos que visem esclarecer os efeitos tóxicos crônicos decorrentes dos rejeitos de minério liberados ao ambiente.

Objective: to analyze the scientific evidence existing to date that describes the toxic effects caused to human and the environmental health, due to the release of ore tailings, resulting from the rupture of the Fundão dam in Mariana-MG. Methods: the narrative literature review was based on a search for articles in four databases: PubMed, SciELO, Science Direct and LILACS, using the descriptors "Dam", "Fundão" and "Mariana" together with the Boolean operator "AND". Results: thirty-four, of the eighty-five publications found, met the inclusion criteria and were used to compose the present review. The following toxic effects were observed: contamination of water and soil mainly by heavy metals, genotoxic, cytotoxic and mutagenic potential of water, decrease in microbial diversity, contamination of fish, loss of vegetation, and impairment of plant growth metabolism. Among these metals, increased concentrations of iron, manganese, copper, cadmium, lead, arsenic, chromium, magnesium, aluminum, mercury, cobalt, barium, nickel and selenium were reported. In addition, the disaster promoted an increase in the number of cases of human diseases, such as dengue, respiratory, dermatological, intestinal, psychological and behavioral diseases. Conclusion: all the scientific evidence exposed in the present review that there was environmental contamination, as well as of the local population, by toxic agents present in the ore tailings, especially heavy metals, released after the collapse of the Fundão dam. Thus, further studies aimed at clarifying the chronic toxic effects resulting from the ore tailings released into the environment are essential.

Estudo experimental da translocação, percolação e lixiviação dos metais presentes no rejeito de mineração: rompimento de barragem em Mariana-MG / Experimental study of translocation, percolation and leaching of metals present in mining tailings: dam failure in Mariana-MG

A exploração mineral é uma relevante atividade econômica desenvolvida no Brasil, principalmente, no Estado de Minas Gerais. A região do Quadrilátero Ferrífero é considerada uma das maiores províncias poliminerais do Planeta e possui importantes reservas de minério de ferro, manganês, níquel, alumínio e ouro. Com o rompimento da barragem de Fundão em Mariana-MG, em 2015, milhões de toneladas de rejeitos extravasaram ficando depositados no solo e nos recursos hídricos. A carga de rejeitos atingiu, primeiramente, a Barragem de Santarém, provocando o seu galgamento, subsequentemente, alcançou o subdistrito de Bento Rodrigues, Rio Gualaxo do Norte, Rio Carmo, Rio Doce e Oceano Atlântico. Foram 663,2 km de corpos hídricos diretamente impactados, 41 municípios e dois estados atingidos: Minas Gerais e Espírito Santo. Diante da magnitude dos danos provocados ao ecossistema e carência de informações e de estudos na área da saúde, esta pesquisa tem por objetivo avaliar as concentrações de metais na área afetada pelo rompimento da barragem de rejeitos de mineração e simular, experimentalmente, a translocação, percolação e lixiviação desses metais no ambiente. Foram realizadas coletas de solo natural e rejeitos in loco, nos locais mais afetados pelo rompimento (Paracatu de Baixo-MG), para análise de parâmetros físicos e químicos. Avaliação do Fator de Translocação dos metais foi desenvolvida em hortaliças (alface, rúcula e rabanete), cultivada com solo natural de Mariana-MG e com rejeitos de mineração. Além disso, foram realizados ensaios de lixiviação e percolação de água em solo contaminado. Considerando os resultados desta pesquisa, foi possível realizar um diagnóstico básico sobre rotas de dispersão ambiental dos metais no solo após ruptura da Barragem do Fundão, Mariana, MG. Após analisar as amostras do solo e rejeitos, foi evidenciado que o As, Pb, Tl, Al e Fe apresentaram as maiores concentrações. Algumas amostras analisadas apresentaram Cu e Ni em concentrações superiores às recomendadas pela Resolução 420 do CONAMA e por normativas da Alemanha. Os resultados dos ensaios com hortaliças apontam amostras que apresentaram Fator de Translocação superior a 1, evidenciando o transporte de metais das raízes até a parte aérea dos vegetais, o que pode representar risco para saúde da população. De acordo com os resultados obtidos durante a simulação de percolação e lixiviação nos cilindros experimentais, verificou-se que ocorreu movimentação de metais na dimensão horizontal e vertical. Os resultados dos ensaios de translocação, percolação e lixiviação mostram, de maneira experimental, diferentes rotas de dispersão dos metais contidos nos rejeitos do minério. Esses resultados permitem inferir o que pode ter acontecido no ambiente após o rompimento da barragem na região de Mariana. Fica evidenciada a necessidade de se dar continuidade a estudos em áreas atingidas pelos rejeitos de mineração a médio e longo prazo, com foco em estratégias de remediação que objetivem a redução de efeitos adversos à saúde nas comunidades assentadas após esse tipo de desastres. Certamente, a obtenção de dados toxicológicos e de avaliações de risco à saúde da população subsidiarão a tomada de decisão e o desenvolvimento de ações intersetoriais, visando à promoção e proteção da saúde e melhoria das condições sociais e de vida da população afetada pelo desastre

Mineral exploration is an important economic activity developed in Brazil, mainly in the State of Minas Gerais. The Quadrilátero Ferrífero region is considered one of the largest polymineral provinces on the planet and has important reserves of iron ore, manganese, nickel, aluminum and gold. With the collapse of the Fundão dam in Mariana-MG in 2015, millions of tons of tailings overflowed, being deposited in the soil and in water resources. The tailings load first reached the Santarém Dam causing its overtopping, subsequently reaching the sub-district of Bento Rodrigues, Rio Gualaxo do Norte, Rio Carmo, Rio Doce and Oceano Atlântico. There were 663.2 km of water bodies directly impacted, 41 municipalities and two states affected: Minas Gerais and Espírito Santo. Given the magnitude of the damage caused to the ecosystem and the lack of information and studies in the area of health, this research aimed to evaluate the concentrations of metals in the area affected by the collapse of the mining tailings dam and to experimentally simulate translocation, percolation and leaching of these metals in the environment. Natural soil and tailings were collected in loco, in the places most affected by the rupture (Paracatu de Baixo-MG), for the analysis of physical and chemical parameters. Evaluation of the Translocation Factor of metals was developed in vegetables (lettuce, arugula and radish), cultivated with natural soil from Mariana-MG and with mining tailings. In addition, leaching and water percolation tests were carried out in contaminated soil. Considering the results of this research, it was possible to carry out a basic diagnosis of environmental dispersion routes of metals in the soil after the Fundão Dam rupture, Mariana, MG. After analyzing the soil and tailings samples, it was evidenced that As, Pb, Tl, Al and Fe had the highest concentrations. Some analyzed samples presented Cu and Ni at concentrations higher than those recommended by Res. 420 of CONAMA and German regulations. The results of the tests with vegetables indicate samples that presented a Translocation Factor greater than 1, showing the transport of metals from the roots to the aerial part of the vegetables, which may represent a risk to the health of the population. According to the results obtained during the simulation of percolation and leaching in the experimental cylinders, it was verified that metal movement occurred in the horizontal and vertical dimensions. The results of the translocation, percolation and leaching tests show, in an experimental way, different routes of dispersion of the metals contained in the ore tailings. These results allow us to infer what may have happened in the environment after the dam collapsed in the Mariana region. The need to continue studies in areas affected by mining tailings in the medium and long term is evidenced, with a focus on remediation strategies aimed at reducing adverse health effects in settled communities after this type of disaster. Certainly, obtaining toxicological data and health risk assessments for the population will support decision-making and the development of intersectoral actions, aimed at promoting and protecting health and improving the social and living conditions of the population affected by the disaster

Júri simulado como estratégia ativa de ensino de vigilância em saúde / Simulated jury as an active strategy for teaching health surveillance

As Diretrizes Curriculares Nacionais para a graduação em Medicina no Brasil destacam que os profissionais de saúde devem estar aptos para realizar ações de promoção, prevenção, reabilitação e proteção em saúde, nas quais a Vigilância em Saúde desempenha papel fundamental. Nesse contexto, este relato de experiência aborda uma estratégia ativa de ensino que visa, por meio de um júri simulado, aplicar conceitos de Vigilância em Saúde (Epidemiológica, Sanitária e Ambiental); fomentar a discussão técnica sobre sua atuação; e discutir vigilância, risco e mitigação do risco em situações de desastres. A atividade foi realizada dentro da disciplina de Saúde Coletiva com participação de 60 discentes do quinto período do curso de medicina e 2 docentes, duração de 4 horas e teve como situação problema o rompimento da barragem do município de Mariana em 2015 e os danos à saúde da população dessa área. Para melhor organização do júri simulado e para assegurar a participação ativa do maior número de discentes nas discussões, os alunos foram divididos nas seguintes funções: júri popular, escrivães, acusação, defesa, testemunhas e peritos. Além disso, as arguições deveriam ser respaldas por literatura científica e aplicar os conceitos epidemiológicos, sanitários e ambientais na situação proposta. Assim, este júri simulado busca aprimorar o processo de ensino-aprendizagem em Vigilância em Saúde por meio de uma atividade prática sobre sua atuação, que ressalte a participação do médico nessa esfera da saúde pública.

The National Curricular Guidelines for medical graduation in Brazil emphasizes that physicians should be able to develop health promotion, prevention, rehabilitation, and protective actions in which Health Surveillance plays a pivotal role. Thereby, this experience report addresses an active teaching strategy that aims, through a simulated jury, at applying the concepts of Health Surveillance (Epidemiological, Sanitary, and Environmental); promoting the technical discussion about its roles; and discussing health surveillance, risk, and risk mitigation in disaster situations. The activity is part of the Public Health discipline, and it was developed with 60 medical students from the fifth period and 2 teachers. The jury lasted 4 hours and the topic was the rupture of a tailing dam in the city of Mariana in 2015, addressing the damages to the health of the population. For better organization of the simulated jury and to ensure the participation of the largest number of students, they were divided into the following roles: popular jury, clerks, prosecution, defense, witnesses, and criminal investigators. In addition, the arguments should be supported by scientific literature and should also apply epidemiological, health and environmental concepts. Thus, this simulated jury sought to improve the teaching-learning process in Health Surveillance with a practical activity about its duties and highlight the importance and the role of physicians in this public health area.

Entre tragédias: percepção e experiências de ribeirinhos atingidos por rompimento de barragens no Brasil - 2016/2020 / Among tragedies: perception and experiences of riverine people affected by the rupture of dams in Brazil - 2016/2020

Introdução: Apesar da mineração existir no Brasil há mais de 300 anos, marcando principalmente a história do estado de Minas Gerais, muitas pessoas souberam que este tipo de atividade é comum em território nacional somente a partir do rompimento de barragens nas cidades de Mariana e Brumadinho, respectivamente nos anos de 2015 e 2019. Objetivo: Compreender o processo pelo qual os ribeirinhos atingidos por tragédias da mineração no Brasil entre os anos de 2015 a 2019 recompõem suas vidas, com uma contribuição etnográfica em uma cidade capixaba. Além disso, pretende-se também compreender como, no período do estudo, o Movimento dos Atingidos por Barragens (MAB) fortalece seu protagonismo e militância atuando junto aos moradores, seja por meio da mídia, registros visuais, narrativas ou construção da memória social do movimento. Método: revisão bibliográfica, pesquisa documental, observação, realização de entrevistas com militantes do Movimento dos Atingidos por Barragens (MAB), registros visuais e registros etnográficos. Resultados: A economia mineral do Estado de Minas Gerais conta com os altos lucros gerados nos últimos anos devido às atividades do setor na exportação de matéria prima. Entre as quinze cidades mineiras que receberam maior CFEM no ano de 2017, Mariana e Brumadinho, terras onde as maiores tragédias ambientais ocorreram nos últimos anos, ocupam respectivamente, a 5ª e a 8ª colocação. Enquanto Minas Gerais recebe grandes compensações financeiras pela exploração de seus recursos, muitos outros municípios de seu estado vizinho, o Espírito Santo, que viram as águas do rio Doce serem cobertas por lama devido ao desastre de Mariana, continuam esquecidos e buscando soluções aos diversos problemas causados à população ribeirinha. Considerações finais: Todas as promessas de revisão de barragens, novas tecnologias, promessas do ponto de vista legal, de política pública, continuam no papel, sem solução para os afetados pelas tragédias. As empresas no entanto, continuaram a crescer do ponto de vista econômico e a criar novas parcerias no mercado nacional e internacional. O dinheiro recebido como recurso da CFEM precisa libertar os municípios da extração de minério. Se sabemos todos os malefícios trazidos por esta atividade, precisamos considerar as circunstâncias e buscar o que cada região apresenta por vocação. Cada local tem suas especificidades, seus modos de vida.

Introduction: Although mining existis in Brazil for more than 300 years, mainly marking the history of the state of Minas Gerais, many people have known that this type of activity is common in national territory only from the breaking of dams in the cities of Mariana and Brumadinho, respectively in the years 2015 and 2019. Objective: To understand the process by which riverine people affected by mining tragedies in Brazil from 2015 to 2019 recompose their lives, with an ethnographic contribution in a city in Espírito Santo. In addition, it is also intended to understand how, during the study period, the Movimento dos Atingidos por Barragens (Movement of People Affected by Dams) (MAB) strengthens its role and militancy by working with residents, whether through the media, visual records, narratives or the construction of the social memory of the movement. Method: Bibliographic review, documental research, observation, interviews with militants from the Movimento dos Atingidos por Barragens (Movement of People Affected by Dams) (MAB), visual records and ethnographic records. Results: The mineral economy of the State of Minas Gerais has the highest profits generated in recent years due to the activities in the sector's exportation of raw materials. Among the fifteen mining towns that received the highest CFEM in 2017, Mariana and Brumadinho, lands where the greatest environmental tragedies occurred in recent years, occupy, respectively, the 5th and 8th places. While Minas Gerais receives large financial compensation for the exploitation of its resources, many other counties in its neighboring state, Espírito Santo, which have seen the waters of Rio Doce being covered by mud due to the Mariana disaster, remain forgotten and seeking solutions to various problems caused to the riverside population. Final considerations: All promises to revise dams, new technologies, promises from the legal point of view, public policy, remain on paper, with no solution for those affected by the tragedies. However, companies continued to grow economically and create new partnerships in the national and international markets. The money received as a CFEM resource needs to free the counties from mining extraction. If we know all the harm caused by this activity, we need to consider the circumstances and find out what each region has as vocation. Each place has its specificities, its ways of life.

Comunidades sujas de lama: da destruição à ressignificação e a resistência em mariana/mg / Comunidades sucias de barro: de la destrucción a la resignificación y la resistencia en mariana/mg / Mud-dirty communities: from destruction to resignification and resistance in mariana/mg, brazil

Resumo No dia 5 de novembro de 2015, o rompimento da barragem de rejeitos de Fundão em Mariana-MG (Brasil) de propriedade das mineradoras Samarco, Vale e BHP Billiton destruiu comunidades e contaminou o Rio Doce, sendo reconhecido como o maior desastre/crime sócio ambiental do Brasil. Nosso objetivo neste artigo é compreender os sentidos de comunidade construídos e acessados pelos atingidos dessas localidades anteriormente ao desastre e após o mesmo. Para tal, recorreremos a dados coletados durante diferentes contatos com o campo realizados pelas três autoras e que incluíram a realização de visitas aos territórios, entrevistas com atingidos e atingidas, observação participante (eventos, reuniões, outros), registro em diário de campo. Os resultados apontam que há uma constante busca por tentar recriar o sentimento de comunidade que se mostra principalmente na manutenção do vínculo com o espaço físico devastado e na tentativa de recriar o mesmo no espaço onde será feito o reassentamento.

Resumen El 5 de noviembre de 2015, la ruptura de la presa de relaves Fundão en Mariana-MG (Brasil), propiedad de las compañías mineras Samarco, Vale y BHP Billiton, destruyó comunidades y contaminó el Río Doce, siendo reconocido como el mayor desastre/crimen socioambiental en Brasil. Nuestro objetivo en este artículo es comprender los significados de la comunidad construida y accedida por los afectados en estos lugares antes y después del desastre. Con este fin, utilizaremos los datos recopilados durante los diferentes contactos con el campo llevados a cabo por las tres autoras, que incluyeron visitas a los territorios, entrevistas con los afectados y afectadas, observación participante (eventos, reuniones, otros) y registro en un diario de campo. Los resultados muestran que existe una búsqueda constante para tratar de recrear el sentimiento de comunidad que se muestra principalmente en el mantenimiento del vínculo con el espacio físico devastado y en el intento de recrearlo en el espacio donde se realizará el reasentamiento.

Abstract On November 5, 2015, the Fundão dam owned by the mining companies Samarco, Vale and BHP Billiton broke in Mariana/MG (Brazil), destroying communities and contaminating the Rio Doce, being recognized as the biggest socio-environmental catastrophe/crime in Brazil. Our goal in this article is to understand the senses of community built and accessed by those affected before and after the disaster. To this end, we used data collected during different field contacts made by the three authors, which included visits to the affected territories, interviews with those affected, participant observation (events, meetings and others), and recording in a field diary. The results indicate that there is a constant search to try to recreate the feeling of community, which is shown mainly in the maintenance of the bond with the devastated physical space and in the attempt to recreate it in the space where the resettlement will be done.

Contaminação mercurial em muscultura de pescado proveniente do Rio Doce, Vila de Regência, Linhares/ES / Mercurial contamination in fish musculature from the Rio Doce, Vila de Regência, Linhares/ES

Em 2015 a queda da barragem de mineração no rio Doce, Minas Gerais, causou impactos ambientais, como o aumento da concentração de mercúrio (Hg). No ambiente o Hg passa pelo fenômeno de biomagnificação e se bioacumula no pescado. Em humanos, o Hg pode ser um risco à saúde coletiva e a contaminação ocorre através da ingestão de pescado com concentrações variadas do metal. Para determinar a contaminação mercurial total (HgT) da musculatura de pescado proveniente do rio Doce, da região de Linhares, Espírito Santo, 121 espécimes foram adquiridas, em novembro de 2016. A musculatura foi avaliada no DMA80® para determinar o grau de contaminação mercurial total, e os resultados médios variaram de 0 a 0,9490 mg/kg. Apesar dos valores estarem abaixo do limite máximo determinado pelas legislações (1 mg/kg), deve-se avaliar o grau de risco de exposição ao mercúrio da população através do consumo do pescado.

Background papers and supplementary technical information

Population growth and the built environment are the primary root causes of morbidity and mortality associated with earthquakes. Earthquakes generally do not cause death and injury, but rather it is the buildings in which people are located and the contents therein that are directly responsible for human mortality and morbidity. Protective action messaging is intended to provide members of the public with information that can be recalled and acted on during earthquake shaking to reduce the chance of death and injury. In order to design appropriate guidance for developing protective action messages for earthquakes, it is important to understand their human impact­that is, how people are injured and killed during earthquake shaking. The purpose of this background paper is to describe the epidemiology of deaths and injuries during earthquakes. The paper will address the major causes of death and injury from earthquakes, including what the research indicates about injuries to building occupants who walk or run, the likelihood of death or injury from earthquakes, the likelihood of death or injury from earthquake-related building collapse, the likelihood of death or injury from substandard building evacuation routes during earthquakes, and other sudden onset threats, such as tsunami or fire. The health effects of earthquakes can be categorized in a variety of ways. Combs, Quenemoen, Parrish, and Davis (1999) developed a typology, which has been adopted by the U.S. Centers for Disease Control and Prevention (CDC), for categorizing the health effects attributable to earthquakes and other disasters based on two parameters: (1) the time the death or injury occurs relative to the event, and (2) whether the event is directly or indirectly related to the disaster. Deaths and injuries that are directly related are those that are caused by the physical forces of the event, whereas indirectly related deaths and injuries are, "those caused by unsafe or unhealthy conditions that occur because of the anticipation, or actual occurrence, of the disaster" (Combs et al., 1999, p. 1125). This paper will focus primarily on human deaths and injuries occurring during earthquakes that are directly related to the event.

Identifying earthquake-unsafe schools and setting priorities to make them safe: a case study In Gujarat, India

After the January 26, 2001 Gujarat Earthquake, GeoHazards International (GHI) was concerned about the risk of school buildings in the largest Gujarat cities and asked the Volunteers for India Development and Empowerment (VIDE) and NGOs Kobe to help fund a study that would identify earthquake-unsafe school buildings in Ahmedabad, Baroda and Surat. VIDE and NGOs Kobe agreed to help. GHI worked with its Indian partner organization, SEEDS, to evaluate 153 schools: 42 in Ahmedabad, 58 in Baroda, and 53 in Surat. The schools included different structural types, served students from a variety of educational and economic levels, and were widely dispersed within each city. GHI found that the earthquake risk of the schools in all three cities is significant, and recommends that the authorities responsible for these schools take steps to reduce the risk. GHI further recommends that these authorities initiate comprehensive school earthquake risk mitigation programs. GHI and SEEDS will meet with officials in these three cities to discuss these findings and follow-up actions. After this meeting, this report will be revised.

RADIUS: risk isessment tools for dagnosis of urban areas against seismic disasters

Urban seismic risk is rapidly increasing, particularly in developing countries, where a number of mega-cities are growing.Almost half of the world population lives in cities, where all kinds of human activities are concentrated. Thus, cities are more and more vulnerable to disasters, particularly to earthquakes, which can strike any city suddenly without warning. Once an earthquake takes place in a large city,the damage can be tremendous both in human and economic terms. Even an intermediate earthquake can cause destructive damage to a city as in the cases of the 1995 earthquake in Kobe. Japan and the 1999 earthquake in Kocaeli,Turkey. There is a tendency to think that disaster prevention would cost much more than relief activities. However, the reality is the reverse. Our society has been spending a lot of resources for response activities after disasters; these resources could have been drastically reduced if some had been spent for disaster prevention.There is also a tendency to look at disasters mainly from a humanitarian angle, bringing us into the position of giving priority to the response to disasters. However, relief activities can never save human lives that have already been lost. Response activities can never help immediately resume functions of an urban infrastructure that have already been destroyed. The bottom line is that buildings should not kill people by collapsing and infrastructure should not halt social and economic activities of the city for a long time. It is essential particularly for seismic risk reduction to concentrate our efforts on prevention and preparedness.The secretariat of the lnternational Decade for Natural Disaster Reduction (IDNDR 1990-2000), United Nations, Geneva, therefore, launched the RADIUS (Risk AssessmentTools for Diagnosis of Urban Areas against Seismic Disasters) initiative in 1996, with financial assistance from the Government of Japan. It aimed to promote worldwide activities for reduction of seismic disasters in urban areas, particularly in developing countries.

Acute PTSD in Survivors of a Building Collapse Accident in Seoul: A Preliminary Study on Incidence, Predictors and Pattern of Symptom Changes / 신경정신의학

OBJECTIVE: This is a prospective clinical study on survivors of the collapse accident of a major department store building occurred in Seoul in lune 1995 to investigate the incidence of acute PTSD, to identify risk factors affecting the severity of PTSD symptoms, and to evaluate the pattern of symptom changes over time. METHOD: Thirty-two victims were interviewed with modified Korean version of the PTSD-I(DSM-III-R) to determine the severity of symptoms and diagnosis of PTSD. Degrees of anxiety and depression were measured with Hamilton's Anxiety Scale(HAS) and Depression Scales(HDS) respectively. Subjects were assessed in series at one month(time point 1) and three month(time point 2) from the time the accident occurred. RESULTS: The incidence of PTSD in the subjects over the 3 months was 41% using by full criteria and 48% by partial criteria. Regression analysis at the time point 1, the HDS score, which was partially related with death of accompanied persons(friends/relatives/colleagues), contributed significantly to the PTSD-I variances. At the time point 2, loss of consciousness contributed significantly to the variance of the PTSD-1, HDS and HAS scores. Between tire point 1 and time point 2, the overall severity of PTSD symptoms far all the subjects has remained almost unchanged. However, re-experience and hyperarousal symptoms were improved in comparison with avoidance symptoms, although not statistically significant. CONCLUSIONS: This study result show a high risk of developing PTSD and partial PTSD among the building collapse victims. The death of accompanied person, severity of depression and loss of consciousness are all regarded as major factors affecting the severity of PTSD. Of PTSD symptom clusters, avoidance symptoms are likely to be less changeable than reexperience and hyperarousal symptoms over time.

Clinical Features of Long Term Confined Patients Due to a Building Collapse Disaster / 대한신장학회잡지

Following the department store building collapse disaster on June 29, 1995, more than 140 people were brought to emergency care center of the Catholic medical center. Among them three starvated people due to long term confined in the collapsed building and one severe crush injured patient developed to prerenal azotemia and ARF. Case 1, 21- year-old man had been confined in the collapsed building debris for 11 days, he had been able to drink water and showed only mild dehydration on admission. Case 2, 3, 18-year-old woman and 19- year-old woman had been confined for 13 and 17 days even without water intake. They were severely dehydrated, hypotensive and hypernatremia on admission. Case 4, 39-year-old man was crushed by building debris and rescued 22 hours later and was diagnosed as ARF due to traumatic rhabdomyolysis. Case 1, 2 and 3 improved immediately only with fluid therapy. Case 4 progressed to acute tubular necrosis, in spite of therapy, and required hemodialysis. Severe dehydration due to long term starvation in young healthy person over 17 days did not progressed to acute tubular necrosis only with adequate fluid therapy. To prevent acute tubular necrosis in crush injured patient, needs more immediate and intensive fluid therapy at the rescue and careful correction of hypernatremia.