After the flooding that has killed more than 5,000 people in Libya and left thousands more missing, the country could be hit by potentially fatal disease outbreaks.
There is an increased risk of waterborne diseases as well as of infections spread by mosquitoes, doctors say.
Health services may have been damaged in some areas, making it more likely those that continue to operate become overwhelmed with ill or injured patients.
“In a crisis on a major scale, like in Libya, we have the breakdown of sanitation, we have the breakdown of water [supplies] and we have a lot of deaths – animals as well as humans,” Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter Medical School in the UK, said.
“Therefore there’s every possibility of infections spreading into, for example, the water supply.”
The port city of Derna in the north-east was particularly heavily hit after two dams burst and unleashed tsunami-like floodwaters.
Paul Hunter, an infectious diseases specialist and professor in medicine at the University of East Anglia in the UK, who has previously researched the health effects of floods, said that one of the most obvious concerns was the threat of waterborne diarrhoeal diseases, including cholera.
“All the [faeces] in the pit latrines gets washed out,” he said. “If people drink that water, because there’s no other water, and they cannot sterilise it, they can pick up illnesses.”
Thousands died after Haiti was badly hit by a cholera outbreak that emerged in late 2010, the same year that the country suffered a devastating earthquake.
Cholera outbreaks, while a possibility, are not inevitable after flooding, Prof Hunter said, with the risk depending on the existing prevalence of the bacteria that causes the disease.
Vector-borne diseases, such as those spread by mosquitoes, could also spike.
“Anything that lays its eggs in water will have a field day for a short period of time,” Ian Jones, a professor of virology at the University of Reading in the UK, said.
Polio-like viral infections that do not cause paralysis but are associated with gastrointestinal problems and diarrhoea could increase, Prof Jones added.
Among the other viral infections that may emerge in greater numbers, Prof Hunter said, are dengue fever and Hepatitis E, which can be fatal, particularly in pregnant women.
An infection known as aspiration pneumonia may result from near-drowning episodes of the kind that can happen with flooding.
“What happens is that you breathe dirty water into your lungs and that can cause infection,” Prof Hunter said.
Wound injuries are more likely to result in an infection because water is dirty from the flooding, while incidents of broken bones and heart attacks are also likely to have increased.
Devastation of the kind that parts of Libya have experienced also increases the risk of chemical contamination of the water supply, Dr Pankhania said.
There have been widespread reports of Libya’s health system struggling as a result of the civil war that has raged for more than a decade. Extreme events can worsen the situation by destroying healthcare facilities and leaving those that remain overwhelmed.
In these circumstances, Prof Hunter said, normal standards of hygiene in hospitals are harder to maintain, making the spread of disease even more likely.