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Floods in Valencia pose risks of infections and intoxications, challenges to mental health and to the supply of drugs and food, which affect the vulnerable population the most and must be addressed in a coordinated manner. In the face of such events, the overall strengthening of a country's healthcare system is critical. Since the beginning of the DANA last Tuesday, October 29, which mainly affected the region of Valencia, more than people have died and dozens are still missing due to severe flooding.

In a few hours, the equivalent of a year's worth of rain fell in some areas, causing large floods that swept away entire towns, trapping thousands of people. This type of environmental disaster can have short- and long-term cascading effects on physical and mental health, and can indirectly affect health and well-being as a result of evacuation, social disruption, financial loss, change in lifestyle, damage to health care facilities, and changes in the broader political and socioeconomic context.

Cascading disasters can be defined as extreme events, where the effects increase in progression over time and generate unexpected secondary events that have a strong impact and tend to contribute substantially to the overall duration of the disaster. A key element is that they have an escalation point, a junction in a chain of reactions that leads to greater effects than the initial disaster would have had.

Cascading disasters are extreme events, in which the cascading effects increase in progression over time and generate unexpected secondary events of strong impact. The disaster management cycle establishes four stages : prevention, preparedness, response and recovery.

The response phase, in which there is still a certain degree of overlap with the recovery phase, concerns the actions to be taken during the emergency and includes the preferential use of human resources and technical means, the rapid assessment of needs to enable the notification of the specific aid required. It should aim to ensure the functioning of vital systems drinking water, energy, communications, etc.

Moreover, at this stage, in terms of public health, the health objectives of disaster management should be to prevent and reduce mortality; care for victims and prevent after-effects; prevent indirect health-related effects; prevent morbidity in the short, medium and long term; and reestablish basic health services.

The public health response to a disaster has to be tailored to the specific hazards depending on their causes and the specific situation. The United Nations Office for Disaster Risk Reduction defines a disaster as a serious disruption of the functioning of a community or a society on any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts.

These are a series of recommendations for the consequences for public health after a natural disaster such as the one that occurred, which are varied and may appear in the short and medium term. They contain some basic general measures and other specific ones in relation to dead bodies, water and food, cleaning and disinfection, waste management, prevention of carbon monoxide poisoning CO and coordination of volunteer health personnel who offer to collaborate.

Some infectious diseases that may be favored by flooding are: leptospirosis, hepatitis A, tetanus, gastroenteritis and gastrointestinal infections or mosquito-borne diseases. Likewise, SESPAS highlights the urgency of setting up the State Public Health Agency , an entity that will improve coordination between public health administrations, the sharing and analysis of socio-health information, the communication of this information to professionals and citizens and the evaluation of the health impact of the programs implemented.

One of the most serious dangers in an emergency situation such as the current one is the risk of epidemics and poisoning due to the contamination of drinking water. Flood waters and mud pose a serious health risk because, when in contact with garbage and animal carcasses, they create the ideal breeding ground for microorganisms. Specifically, some of the infectious diseases that can be favored by flooding are: leptospirosis, hepatitis A, tetanus, gastroenteritis and gastrointestinal infections or diseases transmitted by vectors, especially mosquitoes.

Spain has a very powerful public health and prevention system that allows the control of many diseases, such as those that are waterborne. However, in a circumstance like this, in which sanitation systems and access to drinking water have been affected, there may be a risk of infection associated with the ingestion of contaminated water or food, such as those caused by pathogens like E.

Therefore, it is very important to maintain and recover as soon as possible the supply of clean and safe water for drinking, cooking, washing, as well as electricity and food supply, in addition to soap and other basic cleaning products.

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Therefore, in addition to informing the population about hygiene measures to be implemented during and after the flood, it is important to involve health professionals who have experience in the prevention of epidemics and risks related to water contaminated by pathogenic microbes. Another major challenge to be addressed during an environmental catastrophe such as the TLD is that of mental health, both of those affected and of the health workers themselves.

In the case of people directly affected by the tragedy, such as those who have lost people in their environment or material belongings, there is a risk that in some cases the trauma may result in long-term psychological suffering. In particular, depression and post-traumatic stress disorder are the two main disorders from which survivors may suffer.

Early intervention by psychologists specialized in emergencies is essential for the emotional recovery of those affected and to prevent long-term psychological problems. Post-traumatic stress will affect three groups: those who have seen dead bodies, those who feel intense guilt for having survived or for not having been able to help more, and those who were previously in treatment or had experienced similar situations.

A community approach minimizes the impact by proactively meeting the needs of each affected person. Above all, it will affect three groups: those who have seen dead bodies, those who feel intense guilt for having survived or for not having been able to help more, and those who were previously in treatment or had experienced similar situations, such as the floods.