Contents lists available at ScienceDirect International Journal of Disaster Risk Reduction journal homepage: www.elsevier.com/locate/ijdrr Assessing the public health impacts of disasters: A retrospective study of the October 2015 Hindu Kush earthquake in Pakistan Junaid Ahmad a, ⁎ , Mokbul Morshed Ahmad b a Disaster Preparedness, Mitigation and Management (DPMM), Department of Development and Sustainability, Asian Institute of Technology (AIT), Khlong Luang, Pathumthani 12120, Thailand b Regional and Rural Development Planning - School of Environment, Resources and Development at the Asian Institute of Technology (SERD), Asian Institute of Technology (AIT), Thailand ARTICLE INFO Keywords: Earthquake Public health Pakistan Disaster-induced health risks Disaster medicine Disaster epidemiology ABSTRACT It is well-established that the rate of natural disasters has increased in the last three decades, with millions of people affected. The direct impacts of disasters, including earthquakes, have been monitored and documented; however, only limited information is available on the impact of natural disasters on healthcare institutions and communities. Even less information is available on the different ways in which aftereffects of these events are reflected in global and public health indicators. This study aims to assess and analyze earthquake-related public health impacts on communities and their health service-providing institutions. To this end, we conducted a case study of ten districts hit by the October 2015 Hindu Kush earthquake in Pakistan. We grouped these districts into two groups of five each: Group I include the districts most seriously affected by the earthquake in terms of death toll, number of injured and structural collapses; Group II includes the less-affected districts, which experienced lower mortality and injury rates and less structural damage than those in Group I. We retrieved six years of monthly data from the District Health Information System of the selected districts and analysed it to examine trends of ten indicators in pre- and post-earthquake contexts. Findings from both groups revealed that districts in Group I showed significant variation in trends relating to rates of communicable disease, e.g. tuberculosis and hepatitis C; of vector-borne diseases, e.g. malaria; and of psychological problems such as depression and anxiety. On the other hand, trends in indicators relating to health care services including antenatal care, immunization coverage, and postnatal care remained stable. It can be concluded that earthquakes does impact the health status and utilization of health service services within affected communities. 1. Introduction Of the 1.35 million people killed by natural disasters over the past twenty years, more than half died in earthquakes [1]. The number of empirical studies that have validated why, and to what extent, certain groups of people are more vulnerable than others during disasters is exceedingly limited, especially in the domain of public health [2].A series of well-publicized disasters in the early 1970s triggered the sci- entific interest of the public health community [3]. These studies em- phasized elderly people, pregnant women, children under the age of five years, and people with disabilities, as they were considered the most vulnerable populations; until recently, though, no concrete evi- dence has been presented to validate such assumptions [4,5]. Even though a limited number of epidemiological studies are available, it is a well-established fact that the impact of earthquakes increases exponentially if they co-occur with a disease outbreak [6]. When an earthquake hits any part of the world, inhabitants of that area are affected regardless of sex, age, economic standing, or social status [7]; however, the highest mortality and morbidity rates often belong to specific population groups: the poor, women, children, the elderly, people with disabilities, etc. [8,9]. In addition, the devastating impacts of earthquakes of the same magnitude and intensity may be very dif- ferent when they occur in developing rather than developed countries [9]. In the past, such disasters have resulted in massive social disrup- tion, widespread death, and outbreaks of epidemic disease [10], causing communities to be paralyzed and survivors to be completely dependent on outside aid. The 2030 agenda for Sustainable Development Goals (SDGs) and the 2015–2030 Sendai Framework for Disaster Risk Reduction (Sendai Framework) both intend to reduce the number of lives lost and mini- mize human suffering from natural disasters across the globe [11,12]. This will be possible only if Disaster Risk Reduction (DRR), Public https://doi.org/10.1016/j.ijdrr.2018.01.004 Received 23 May 2017; Received in revised form 3 January 2018; Accepted 5 January 2018 ⁎ Corresponding author. E-mail addresses: Junaid.ahmad@ait.asia, Junaid527@gmail.com (J. Ahmad), morshed@ait.asia (M.M. Ahmad). International Journal of Disaster Risk Reduction xxx (xxxx) xxx–xxx 2212-4209/ © 2018 Elsevier Ltd. All rights reserved. Please cite this article as: Ahmad, J., International Journal of Disaster Risk Reduction (2018), https://doi.org/10.1016/j.ijdrr.2018.01.004