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Accident and disaster epidemiology.

Natural disasters such as floods, earthquakes, and cyclones are responsible each year for a large number of deaths and injuries. Over recent years, the emphasis in disaster management has shifted from post-disaster improvisation to pre-disaster planning. There is a strong feeling that one should be able to prevent or mitigate the human consequences through improved preparedness. The decade 1990-99 has been proclaimed by the United Nations the International Decade for Natural Disaster Reduction (IDNDR). Epidemiology is proving an essential tool to study the health effects of disasters and to suggest appropriate control measures at each of the phases of the disaster process, from prevention to long-term rehabilitation. Case-studies have shown that rescue by the disaster-struck community is the most effective way to reduce the death toll due to earthquakes. Disaster preparedness should be part and parcel of primary health care in disaster-prone areas. Appropriate information to evaluate needs should be preferred to precipitate relief. Epidemiological surveillance should replace indiscriminate vaccination. In the long term, disaster preparedness can provide a stimulus for setting up more efficient health services.