Health Systems Brace for Public Health Threats

As Spain’s southeastern regions battle the repercussions of flooding caused by a storm system known as DANA, healthcare systems are being pushed to their limits. Floodwaters have closed healthcare facilities, spurred evacuations, and interrupted services, raising alarm about the public health consequences that will follow.

Flooding has severely affected medical facilities, making access to routine care challenging, especially in hard-hit areas such as Torrent, Valencia. Local general physician Vicente Gasull described the devastation to local infrastructure: “Of the three bridges we have to cross, only one is still standing.” Many health centers have been inundated, and several towns have resorted to setting up temporary clinics in sports centers to continue essential care.

“The pharmacies, [which are generally] located on the ground floor, are all flooded. They have set up collection and delivery points for medicines, but the problem is that the communication routes are not available,” Gasull explained to El Médico Interactivo, a Medscape Network website.

Gasull highlighted the logistical challenges faced by healthcare providers as roads damaged or blocked by floodwaters have forced them to rely on alternate routes or coordinate between towns to ensure patients receive the necessary care.

In response, Valencia’s regional ministry of health has established a register of volunteer health professionals available to help in affected areas. Health professionals signing up via this register become part of an information system shared with primary care directors in the affected regions. Launched on November 1, this registry gathers essential details, such as the volunteer’s field of expertise — whether in medicine or nursing — as well as their specialty and availability.

Coordinators from impacted health departments reach out to registered volunteers by phone to coordinate activities under the direction of local health officials. The ministry has emphasized prioritizing volunteers from the Valencian health system during the initial phase of the response.

Volunteer Safety

To minimize the infection risks to volunteer healthcare providers and other personnel, the Spanish Ministry of Health has issued stringent safety protocols.

Individuals participating in flood cleanup efforts should wear long-sleeved clothing and trousers to cover the arms and legs completely. Additional protective measures include wearing a mask; eye protection; and gloves to guard the nose, mouth, eyes, and hands while cleaning. After removing gloves, thorough handwashing with soap and water is essential. If soap and water are unavailable, hydroalcoholic gels can be used. Contaminated clothing should be washed with hot water and detergent to ensure hygiene.

It is advised that individuals with underlying health conditions, particularly respiratory issues or weakened immune systems, as well as children and pregnant women, avoid participating in cleanup activities owing to heightened health risks.

If a dead person is found, they should not be touched. Instead, authorities should be contacted immediately. Similarly, animal remains should not be handled directly. Local guidance from municipal authorities should be followed to manage these situations safely.

Anticipated Health Risks and the Phased Response Plan

The flooding has heightened the risk for infectious diseases, particularly due to contaminated water sources and the proliferation of bacteria and pathogens in affected areas.

“Any wound [that comes into contact] with mud and decomposed products can be dangerous, underscoring the infection hazards in flooded areas,” noted Gasull. 

The Spanish Society of Emergency Medicine has outlined three potential phases in disaster situations in anticipation of a wave of infections:

• Phase 1 (0-4 days): Immediate injuries and acute trauma treatment are prioritized as emergency rescue operations are underway.
• Phase 2 (4 days to 4 weeks): The risk for waterborne and airborne infections rises, especially as sanitation infrastructure remains compromised. 
• Phase 3 (after 4 weeks): Infectious diseases with longer incubation periods, such as certain vector-borne illnesses, may become prevalent, requiring extended monitoring and potentially intensified medical response.

Emergency experts are on alert for early signs of disease transmission, especially because floodwater may facilitate the spread of these diseases:

• Diarrhea: This is the most common flood-related condition, often due to ingestion of contaminated water and food. Such factors as shared water containers and poor sanitation practices increase its spread, making access to clean water and soap crucial.
• Leptospirosis: Endemic to areas such as Valencia’s Albufera lagoon, leptospirosis can spread through contact with water or soil contaminated by animal urine, especially from rodents. The disease is often mild, but severe cases may lead to organ failure. Early antibiotic treatment can be effective.
• Tetanus: With flood-related injuries, the risk for tetanus rises, particularly among unvaccinated persons. Authorities recommend disinfecting all wounds and prioritizing vaccination to prevent outbreaks.
• Hepatitis A: This virus spreads via the fecal-oral route, commonly through contaminated food or water. Drinking bottled or boiled water, thorough food washing, and good hand hygiene are key preventive measures.

Children and Vulnerable Populations at Higher Risk

The Spanish Association of Pediatrics (AEP) has expressed concerns regarding the impact of floods on children, one of the most vulnerable groups in disaster scenarios. Children are at increased risk for respiratory illnesses and waterborne diseases due to prolonged exposure to damp environments and contaminated water sources. Additionally, flood-induced stress has been shown to contribute to long-term mental health issues in children, with the AEP estimating that about 25% of young survivors might experience posttraumatic stress, anxiety, or depression.

The AEP advocates for accessible mental health resources within affected communities and emphasizes the importance of communication between children and parents to help young ones cope with trauma. In areas prone to flooding, studies have also linked prenatal exposure to flood conditions with lower birthweights, highlighting the critical need for health support not only for children but also for pregnant women.

Long-Term Health Recommendations and Public Advisory

To address the long-term health impacts of flooding, Spain’s health authorities have issued specific recommendations aimed at both residents and healthcare providers. Key recommendations include:

• Residents and workers are advised to wear full protective clothing when handling flood-damaged materials and to wash clothing in hot water after exposure. These measures reduce the risk of bringing contaminants back into homes or spreading infection among family members. 
• Floodwater should not be used for drinking, bathing, or cleaning to prevent exposure to pathogens, and residents are encouraged to boil or use bottled water if local supplies are compromised. 
• With floodwaters receding, communities are urged to eliminate standing water around homes and public areas to reduce the risk for mosquito-borne diseases, which can increase in areas near stagnant water after flooding. 
• Floodwater can leave homes damp for days, increasing the risk for mold growth, which becomes hazardous after 48 hours. Mold exposure can lead to such symptoms as nasal congestion, sore throat, cough, shortness of breath, and rashes. Individuals with asthma or mold allergies may experience severe reactions, and those with weakened immune systems or chronic lung disease may face serious infections. To prevent mold-related health issues, thorough remediation is critical. The US Centers for Disease Control and Prevention provides guidelines to support safe cleanup after natural disasters. 

As the Spanish Medical Association and public health entities work to provide both immediate and long-term support, authorities also stress that people seeking to help can contribute by donating funds to credible local organizations involved in relief efforts. This coordinated response aims to support healthcare workers on the ground, enhance public awareness, and mitigate the widespread health risks posed by one of Spain’s most severe flood crises in recent history.

This story is an adaptation based on stories from Univadis Spain and El Médico Interactivo, part of the Medscape Professional Network.