The Recovery Stage - Short Term and Long Term Public Health Concerns. After a catastrophe, as days turn to weeks, the rescue period gradually transforms into the recovery and reconstruction period. The focus of the volunteers and emergency health personnel turns from stabilising patients and treating immediate traumatic injuries to assessing and addressing public health concerns. Survivors turn their attention from searching for other victims to restoring communities and rebuilding lives. The most pressing public health concerns include quickly establishing adequate hygiene protocols, controlling the outbreak of endemic diseases, and re-establishing routine health activities. The resumption of common medical practice in the shadow of major destruction from a large natural disaster can be accomplished through the utilisation of outside medical aid, or the establishment of several temporary hospital and clinics in suitable locations. The application of any medical system to a disaster region depends heavily upon the local conditions, availability of equipment, prevailing cultural practices, and the number of victims on hand. One of the primary goals of local health officials in the wake of a major disaster is to resume the normal health practices of the region. This includes the normal operations of all local hospitals and clinics, disease monitoring systems, and all public health programs. Additionally, any disease control programs that were in operation before the disaster must continue. Despite common misconceptions, most outbreaks following a natural disaster are not exotic or rare diseases. Public health officials should instead be vigilant of endemic and common illnesses. Vector control programs are the single most effective method of controlling diseases such as malaria, while vaccination programs are extremely effective for preventing outbreaks of illnesses such as measles, whopping cough, and poliomyelitis. As survivors may find themselves without access to clean running water, personal hygiene conditions may quickly deteriorate. Disaster victims may allow their personal hygiene to depreciate due to the traumatic psychological effect of the surrounding destruction, the possibility of extremely low standards of living before the disaster, and simple ignorance to the use and maintenance of provided sanitary installations. In many cases, sanitary education is needed to ensure that victims properly dispose of refuse, maintain the cleanliness of temporary shelters, and do not waste or contaminate potable water. Education should also be provided indicating what food reserves are safe and how food should be prepared considering the resources that are available. A community's overall sanitation may be compromised by shattered water and sewer lines or malfunctioning filtration plants which can lead to an increase in diseases such as dysentery and cholera. It is vital to note that children are especially vulnerable to dehydration as a consequence of chronic diarrhoea. The lack of refuse removal can increase the amount of contact that individuals may have with disease vectors such as rodents and insects. Consideration must be given to removing prefe rential vector breeding grounds, such as stagnant water, that are in close contact with population concentrations. Furthermore, vector control should be initiated with pesticide spraying and rat eradication programs. Note, however, that all pesticides in sufficient quantities are toxic to humans and thus a balance between vector management and pesticide toxicity must be sought. Crowding and unsanitary conditions at temporary shelters is a major contributor to increased disease transmission in the aftermath of a natural disaster. As individuals find themselves in close proximity to one another, an outbreak of a communicable disease can quickly evolve into a mass epidemic. All precautions should be taken to ensure that a basic minimum of sanitation is kept in all shelters. In the event of an infectious disease outbreak, the affected individuals should be quarantined as best can be from individuals with no apparent symptoms. Diseases that commonly affect shelters include influenza, measles, whooping cough, tuberculosis, and scabies and other skin infections. Mass population movements by victims may also influence the transmission patterns of certain diseases. Displaced people may introduce new and unusual diseases into an area affecting the indigenous population. Likewise, the displaced population could also be infected by locally endemic diseases, which are not common in their homeland. Additionally, the presence of mass numbers of refugees can also place an insurmountable burden upon local resources such as water, leading to an increased incidence of illness among the total population. As local supplies dwindle, the risk of large-scale malnutrition also increases. Food shortages may arise due to the destruction of food stocks or the disruption of distribution networks from food storage centres. The risk of population wide malnutrition is heavily dependent on the community's nutritional status before the disaster. Populations who were experiencing food shortages or famines in the pre-disaster period are almost certain to experience nutritional problems during the recovery and reconstruction phases. The nutritional status of a population not only affects its functionality, it also contributes to an individual's ability to recover from disease or resist infection entirely. It has been observed that feeding malnourished victims leads to a greater survival rate from diseases such tuberculosis and malaria, especially among children. It is crucial to consider that when a community's health services fail, certain populations are at greater risk to illness or death than others. In the aftermath of a catastrophe, when medical aid is basic and uncoordinated at best, patients with pre-existing medical conditions run an immense risk of either developing co- morbid conditions or exacerbating their present situation. Individuals with regular health care needs such as dialysis patients can be prevented from reaching a medical facility due to disruption of transportation networks. Furthermore, hospitals, which are inundated with disaster victims, shift their focus to more immediate trauma injuries and away from non-urgent cases. Both the very old and the very young have a disproportionately higher risk of health problems during the recovery and reconstruction period of a catastrophe. The elderly are less able to recover from physical injuries sustained during the natural disaster and appear to be more susceptible to stress related illnesses, such as myocardial infarct. Children on the other hand appear to be more disposed to infections and severe diarrhoea. In addition, the poor and homeless of a community are extremely vulnerable to the health effects of a natural disaster. In many cases, the poor are suffering from previous medical conditions such as malnourishment or respiratory infections, which reduce their ability to cope with the further reduction of available resources. In a large-scale disaster, thought must be given to the collection and transport of the deceased. In order to properly protect the community's health and well being, disaster workers must arrange for the proper transport, storage, and disposal of human corpses. Health workers should attempt to discretely and quickly remove all bodies from the disaster scene to an area where they are to be prepared for burial or cremation. Every possible effort should be made to identify the deceased and notify the next of kin and other relatives. An official register of deaths should be drawn up which should indicate where the body was located, the most likely cause of death, and other identification particulars. Personal belongings should be returned to relatives if possible. In many cases, a balance must be found between burying or cremating the body as soon as possible for health reasons, or waiting to facilitate identification and notification of family.