Earthquake tests China's emergency system
Authors: Yadan Ouyang
Journal: The Lancet (2013)

The recent earthquake in China's Sichuan province struck just ahead of the 5-year anniversary of the 2008 Wenchan earthquake. Was the country better prepared this time? Yadan Ouyang reports. More than 190 people were killed after a 7·0-magnitude earthquake struck China's southwestern Sichuan province at 8:02 am on April 20. The epicentre was in Lushan County, about 116 km away from Chengdu, the provincial capital. The Chengdu Military Region Command dispatched thousands of troops to Lushan 20 minutes after the shock, and in the early afternoon, the first batch of helicopters carrying rescuers and supplies landed in the epicentre. For many victims, the earthquake brought back vivid memories of the catastrophic Wenchuan earthquake that occurred almost exactly 5 years ago on the same fault line and left more than 87 000 people dead or missing. Luo Xining of Sichuan's emergency management office said that although there are still problems, the response and coordination mechanisms have “improved a lot compared to 5 years ago”. Similar to the 2008 earthquake, the region's sparse and treacherous mountain roads proved a serious obstacle to relief efforts. While landslides caused by the earthquake and aftershocks blocked arterial highways to the hardest-hit area, the alternative roads were soon jammed with ambulances, trucks, government vehicles, and private cars. Even though the police immediately took traffic control measures, by the next day a handful of vital road sections still remained congested. Many rescue vehicles were reportedly stuck for hours in immobile lanes. Concerned with the efficiency of relief operations, the government announced a controversial ban on individual volunteers and unauthorised organisations entering the disaster area. As many remote villages remained inaccessible because of continuing landslides, helicopters played an important part in the relief efforts. Within 36 hours after the quake, 28 helicopters dispatched by the People's Liberation Army in Chengdu had evacuated 16 severely injured victims and delivered 17 tonnes of relief supplies. Poor weather conditions, however, hampered the rescue and relief operations at times. The earthquake left at least 196 people dead, 21 missing, 11 470 injured, and 295 000 homeless. The death toll has not risen since April 24. An official assessment of the building damage in the hardest-hit area finds that 96·2% of the public buildings built after the Wenchuan earthquake can still be in use after some restoration. Most of the homes in the villages, however, did not survive. In one village in Baoxing County, 176 of 177 homes, mostly made of bricks and wood, collapsed and cannot be restored. More than 10 000 medical workers, most of whom are local, helped to cope with the disaster. By May 15, the hospitals had admitted 4346 injured victims, of whom 3623 were already discharged. According to the Sichuan Bureau of Health (SBH), with a few exceptions, all of the severely wounded victims in the affected area had been evacuated to periphery hospitals in Chengdu 3 days after the earthquake. None of the critically injured patients in the hospitals died. A spokesman at the SBH said that because the earthquake caused less serious damage and survivors were pulled out faster than in 2008, there have been very few patients with crush syndrome and so far zero cases of gas gangrene. “Instead, many suffered traumatic brain injuries, so there's a bigger need for neurosurgeons”, the spokesman tells The Lancet. About 30 000 tents had arrived within 2 days after the quake while 62 000 more were on their way. Although some victims did not receive supplies in the first few days due to logistical problems, on May 5, the government of Ya'an reported that the need for relief supplies had been met, which stands in stark contrast to 2008 when tents were so scarce even weeks after the quake that Hu Jintao, China's then President, had to order tent manufacturers to make 900 000 tents in a month. As survivors settled into tents, medical workers began to take measures to prevent epidemics of infectious disease. Sprayers have disinfected more than 40 km2 of land and 15 800 tonnes of garbage were cleared. So far there has been no major epidemic reported. According to the SBH, the first team of psychologists arrived in the epicentre 8 hours after the quake. In addition, the Red Cross Society of China and other organisations also have trained psychosocial workers on the ground, helping people cope with the emotional effects of the disaster. “And that's just one of the areas where very significant new capacity has been built”, says Francis Markus, a delegate of the International Federation of Red Cross and Red Crescent Societies. While the government has restricted the access of volunteers and organisations to the affected area, those that were granted permits demonstrated a strong ability to coordinate relief activities more quickly and efficiently. Soon after the disaster, about a dozen of Chengdu-based civic groups formed an umbrella coalition and mobilised overnight to get aid to the affected victims. “We learned that it was hard for a single organisation to provide all the necessary services for a community, so now at each service centre we have several organisations working together”, said Li Yongdong, programme manager at Yizhong Community Development Center, a non-governmental organisation (NGO) that has joined the umbrella group. Li arrived on day 3 with relief supplies and has since been providing community services in a village with his colleagues. Like many other Chengdu-based civic groups, Li's organisation only came into existence after 2008. Li said that instead of concentrating in the epicentre, this time the NGO workers set out to different affected places, whereas in 2008 there were many of what he calls “blind spots”, where survivors hardly got any attention from the outside in the immediate aftermath of the earthquake. He noted that there is now an abundance of basic relief supplies such as water and food. “It almost gives us a headache when we think about the supplies”, he says. This oversupply of relief goods, however, reflects something more profound than a growing enthusiasm for charitable giving. After several scandals over the misuse of donations for the Wenchuan earthquake, the credibility of official channels of charity, including that of government-organised NGOs, were greatly challenged. In 2010, four government officials were sentenced to prison for embezzling a total of 650 000 yuan (US$100 000) of donations for Wenchuan. “People began to question whether the organisations really spent the money on relief work, so they are reluctant to donate money and feel more comfortable to donate goods”, suggested Li. Experts agreed that they have seen improvement in China's emergency response efforts after the earthquake. “The Government's response was admittedly more rapid and efficient”, says Debarati Guha-Sapir, Director of the Center for Research on the Epidemiology of Disasters, a WHO collaborating centre. “You can never do a perfect job in mass casualty situations…In this case, I think relief was in place fast and medical care was well-organised”, she adds. The government, however, has not always been as prepared as this time. It wasn't until 2003, after the outbreak of the severe acute respiratory syndrome exposed deep weaknesses in the country's emergency response system, that China began drafting contingency plans for public crises including natural disasters. Although the Chinese Government received praise for its prompt response to the earthquake in 2008, the medical workers were nevertheless overwhelmed by the large number and severity of casualties and local government agencies were very much caught off-guard. In 2010, China began establishing 22 health emergency teams across the country to respond to different health emergencies. Among them is a Chengdu-based national medical rescue team with a fully equipped portable hospital, which was seen in action for the first time on April 20 after the quake. Three other such teams from Beijing, nearby Chongqing Municipality, and Shaanxi province were also sent to the affected area, while several others were on stand by. Last May, Sichuan province tested its disaster response system in a training drill that simulated an 8·0-magnitude earthquake. The drill, which involved 10 864 people, included search and rescue, triage, casualty evacuation, and medical treatment. Smaller drills also took place across the province. According to the SBH, two leading hospitals in Chengdu had undergone emergency exercises earlier in the year. Those efforts are commendable, however, as Guha-Sapir points out, China's interest in improving the response system “still remains rather marginal”. Some critics also showed concerns over the once-again insufficient air-rescue system. In a study published last year on the emergency medical rescue after the Wenchuan earthquake, the authors, led by China's then health minister Chen Zhu, concluded that the absence of specialised medical aircrafts posed safety risks to the evacuation of wounded victims. In 2009, dozens of China's top engineers tried to convince the government to establish a national air-rescue system, but so far to little avail. The SBH spokesman said that after this earthquake, building a helicopter evacuation system would be one of the concerns for the government. “Medical rescue and other issues can all be improved if done correctly, but communications and transport disruptions after earthquakes are always the hardest challenges before us”, he concludes.