Disaster Relief Bang Goes the Theory

We live in a world built on technology.

But it's a world that can so easily be destroyed.

An energy crisis,

a pandemic,

a natural disaster.

Or as in the case of Syria, civil war.

So what happens when the modern world falls apart?

And how can science and technology come to the rescue?

This is Zaatari refugee camp in Jordan,

eight miles from the Syrian border.

If I'd stood here 18 months ago,

I'd have seen absolutely nothing - just barren desert.

Now it's home to over 90,000 refugees

who've fled their war-torn country.

And yet these are just a fraction of the millions of people

whose lives have been turned upside down

by war and natural disasters.

When disaster strikes,

it triggers a massive global desire to help

and a huge humanitarian effort swings into action.

But to what extent is that effort shaped by science?

Coming up, Liz finds out

how volunteers are creating crucial maps of disaster zones

without even leaving home.

Anyone, wherever they're sitting, whatever age,

can contribute to disaster relief.

I discover how lessons learnt on the battlefields

are saving lives in Britain.

It doesn't matter whether it's an injury from an IED in Afghanistan

or a road-traffic accident in the UK,

you need to stop that bleeding as soon as possible.

And we're joined by doctor and aid worker Chris van Tulleken

to look at the radical advances being made

in the fight against famine.

How is this changing the way we treat malnutrition?

This has changed the way malnutrition is treated

at a global scale in a way that nothing before has ever done.

Tonight on Bang, the science behind disaster relief.

MUEZZIN'S CALL OVER PA

Two and half million Syrians have now fled their country,

giving up everything for the safety of places like Zaatari.

What was the moment when you decided you absolutely had to leave Syria?

My nephew, my cousin, my friend,

some of them died, burned by regime army.

Whenever I go outside my home, I have to say goodbye to my family,

because I don't know if I will come back again or not.

In less than two years, this camp has grown from nothing

into the fourth largest city in Jordan.

To run it takes over a thousand people

and costs half a million US dollars a day.

HORN BLARES

As with any disaster, getting the priorities right

can mean the difference between life and death.

And at the top of the list

is clean water.

3.6 million litres of water a day are needed to keep Zaatari running,

and originally every single drop was trucked in from outside.

Now there are boreholes, like this one,

and that provides two thirds of the water needed.

But it doesn't matter where the water comes from.

Every single truckload is tested.

We're testing the water samples from this truck

-to help us know the chlorine levels.

-And why do you use chlorine?

We use chlorine because it kills the viruses, the pathogens,

the bacteria in water system.

It is the cheapest way of cleaning the water at this bulk level.

If the water system fails in any disaster zone,

the biggest fear is that cholera could take hold.

After the 2010 Haiti earthquake,

over 6,000 people were killed by cholera,

and nearly half a million more were hospitalised.

Here in Britain, we take our clean water for granted,

but just 150 years ago,

we too were in the grips of a cholera outbreak.

Over 10,000 people had died,

and no-one seemed to be able to find the cause.

Finally, a man named John Snow came up with the theory

that cholera was being spread in the water supply.

He traced the outbreak to a communal water pump in Soho in London,

and he convinced the authorities to remove the handle from the pump

so people couldn't drink from it,

and cases of cholera reduced dramatically.

The John Snow pump is now held here

at the London School of Hygiene and Tropical Medicine,

where scientists study the impact of infectious disease.

-So this is live cholera bacteria.

-It is, yeah.

So this is a liquid culture of cholera.

They look pretty innocuous, but believe me,

this is the bacteria that's responsible for considerable misery

and a huge amount of disease every year.

-I just saw a long one zip across the screen up on the top.

-Yeah.

What is it that allows them to be so mobile?

Yeah, they've evolved over a huge period of time.

They have really exquisite mechanisms for movement,

and one of those is they have a flagella.

It's like a tail, it rotates,

and basically it pushes the cholera bacteria through fluid.

Our guts have a lot of mucus in,

and that bacteria needs to swim through that mucus.

OK, so it's very effective at boring through the mucus,

and then once it gets to our intestinal wall,

-what happens then?

-It produces a toxin.

The toxin actually goes into our cells,

and it changes the functions of our own cells.

It actually forces them to excrete huge amounts of water,

leading to this massive and very rapid fluid loss.

And it's this fluid loss that can be fatal.

Our bodies are made up of 60-70% water,

so for an average person that translates to 40 litres of fluid,

represented in this tank.

Now, a patient with severe cholera

could lose up to one litre of fluids every hour.

And it's not long before this sort of fluid loss causes problems.

After losing just about one or two litres,

the patient will begin to feel mild symptoms,

so they'll have a dry mouth, they'll feel thirsty.

And once they've lost four litres of fluids,

the symptoms will have become moderately severe,

so the patient could feel weak and dizzy

and have neurological symptoms like confusion.

Cellular functions in the body begin to be compromised.

The immune system isn't working properly.

And by the time they've lost eight litres of water,

that's just 20% of body fluids,

the organs will have shut down, quickly leading to death.

So without treatment,

a cholera patient could be dead in less than a day.

The other reason why cholera can be so devastating

is that for as long as the patient is infected,

every drop of fluid that's passed is brimming with bacteria.

Just one millilitre of fluid, just this amount here,

contains a billion cholera bacteria.

So it's easy to see how easily infection can spread

and how one case can turn into 12

and then 100 in a matter of hours.

John Snow might get the accolade

for identifying cholera as a waterborne disease,

but the real heroes of our clean-water systems

are the civil engineers who design our sanitation plants

and use the element chlorine,

injected into our water systems, just as in Zaatari,

to destroy pathogens like cholera.

So, Nick, the last outbreak of cholera in this country was in 1866.

Is there any chance at all that it could happen again here?

The tragedy of cholera is that it is very treatable,

so if you have clean water and you have those systems in place,

you can treat it, contain it.

Of course, just like any other place, any warzone,

any place where you have a natural disaster,

if all of those systems broke down,

then cholera could...can take hold, and in the UK like anywhere else.

But of course the likelihood of that happening here is incredibly remote.

I mean, we've had recent floodings and no cholera.

6:30 in the morning, and the daily routine at Zaatari begins.

This is one of four bread distribution points in the camp.

When a disaster hits any country and normal infrastructures break down,

feeding the population becomes a massive and urgent problem.

Although the nutritional health of the refugees is generally good,

aid workers are concerned about some of the new arrivals from Syria

where food supplies are becoming scarcer

the longer the war continues.

Yes, you're having your arm measured, aren't you?

So just explain what's going on.

She's taking MUAC.

MUAC is the mid-upper arm circumference.

It is an indicator that shows if a child is malnourished or not.

And what was that? That was 11.5, so what does that mean?

It means the child has moderate acute malnutrition.

We provide high-energy food that will help boost the child's weight.

Yeah, that's going to be much better for you.

Sadly, malnutrition is all too common a problem

faced by aid organisations.

Famine still affects more than 840 million people worldwide,

as Dr Chris van Tulleken knows first-hand.

I've worked in parts of the world

where malnutrition has been the single biggest problem,

affecting almost every patient.

Now, it has direct effects on the human body,

particularly on development in children,

but it also makes you intensely vulnerable

to almost every other disease.

Last year, more than three million children were killed by malnutrition.

But an innovative treatment is changing that.

This used to be the standard treatment for severe malnutrition.

It's essentially turbo-boosted milk powder.

It's got extra protein, extra fat, and extra vitamins and minerals.

And to make it up seems pretty simple.

Put it in a jug and add half a litre of water.

But this is where the problems begin.

In the kind of places we need to use this,

clean water is very hard to find,

and any bacteria that are in the water

will start multiplying to dangerous levels

the minute you add them to the milk powder.

And this means that you can really only use it supervised in hospitals.

But the milk formula is being replaced by this.

This is Plumpy'nut,

the first in a range of nutritional supplements

that are revolutionising the way we treat severe malnutrition.

This will keep for two years outside of a refrigerator,

you don't need to add water in order to eat it,

and in this 92g pack there are as many calories

as there are in a triple-decker burger with cheese.

Like many great inventions,

the secret of these nutritional supplements

lies in their simplicity.

It can all be made

from ingredients that are actually quite widely available

in the regions where they're most needed.

It's built on a foundation of peanut butter.

Now peanut butter is actually a pretty good food

containing fibre, protein, carbohydrate and fat,

as well as vitamins and minerals.

You could live a long time eating just peanut butter.

And then we increase the calories by adding oil,

and oil is the most densely calorific thing that you can eat.

That also stops the growth of bacteria

and increases the shelf life.

Then sugar makes it tastier to eat and adds carbohydrate calories.

Milk powder - more protein, fat, sugar -

and also makes it quite palatable, adds a creaminess.

Finally, because many of the people who will be eating this

will be severely nutritionally deficient,

we add extra vitamins and minerals.

Let's see what it tastes like.

It's not bad.

It's like extremely sweet peanut butter, to be honest,

and if you were hungry it would be really delicious.

For such a simple idea, it's having a huge impact.

How is this changing the way we treat malnutrition?

This has changed everything, because we have a product

that is safe to provide outside of a hospital environment.

In enabling them to treat their children at home,

we've been able to go from a couple of 100,000 cases treated globally

to what is close to three million cases on an annual basis.

It's hard to think of any other intervention in medicine

that has had that dramatic an impact in the last ten years.

Is this going to be the end of famine?

I don't think it's going to be the end of famine.

I think it's going to be the end of famine-related mortality.

I think this is going to enable us

to prevent children from dying from this condition,

and that's a huge gain.

Thankfully, here in Britain,

we don't have the horror of severe famine to contend with.

But the problems of malnutrition are still all too common,

especially amongst the sick and the elderly.

In the UK, we know that 15% of older people

-who live in the community are malnourished.

-Really?

Cos as you get older, you eat less, your appetite goes down,

and that's normal ageing.

But it does make you vulnerable to malnutrition.

-So how do you treat it?

-We look at everything,

and so Violet here, we've been working on her nutrition,

but also she has been having some supplements in her diet.

-How are you finding these supplements?

-This is lovely.

And the doctors here are trying to get you to gain a bit of muscle,

-is that right?

-Well, I gather so.

So this has most of the stuff that Violet will need

to gain some weight in it.

So supplements are important,

but they are a small part of the overall picture for a patient.

It's mostly understanding their nutritional needs

and then treating all the medical and social

and psychological aspects as well.

Malnutrition should always be seen as an indicator of much wider problems.

Nutritional supplements like Plumpy'nut

have saved many, many lives,

but they mustn't distract us from addressing those wider problems,

whether we're talking about an elderly person in the UK

who can no longer do their own shopping

or a child in the Horn of Africa

affected by a failed crop cycle and war.

When dealing with disasters,

we all think about the absolute basics of life.

But there's now another element

that aid workers consider to be just as crucial,

and that's information.

Even in the most challenging environments,

modern technology can create access

to First World information systems really fast.

So everyone here in Zaatari enjoys a really good mobile-phone signal.

You've got access to internet,

many of the refugees have got a satellite television.

But there's one piece of information that's really basic

that they haven't had up until now, and that's a map.

By using a combination of satellite data and GPS technology,

aid workers have created a detailed map of Zaatari

that will eventually be given out to all the refugees.

Zaatari is a big and complicated place,

and I can see why, as a refugee,

particularly when you first arrive, a map is essential.

It's not only essential, it's life-saving.

Say, for instance, if there is a fire in one district, in one home,

how would the civil defence know where you live

if you don't know your address?

So that's why we're encouraging people to use these maps, learn them

and, as such, learn their addresses and give it out when needed.

The map has been created using crowd-sourcing software

so that eventually the refugees themselves

will be able to add information as things change on the ground.

And the same technology is now allowing map makers around the world

to map needs and resources in near real-time.

Crowd-sourced mapping

is transforming the way we respond to disasters.

Across the world, communities of online volunteers

are using the power of big data to save lives

without ever having to leave their homes.

When Typhoon Haiyan hit the Philippines last year,

over 6,000 people were killed

and 1.1 million homes damaged or destroyed in a matter of hours.

But at the same time in Britain,

Justine MacKinnon and a team of volunteers

were creating a vital map of the damaged areas

for aid workers using just social media.

So talk me through what goes on within the social media

and how you deal with that information.

How does it all work?

People seem to want to communicate what they're going through,

so a lot of people take photographs of the incident they're in,

they'll write messages,

and they use hashtags, so #Haiyan.

So with Haiyan, for example,

how many messages, images, videos

from all the social-networking sites were you receiving a day?

-On average, a million a day.

-A million a day?

-One million a day.

After filtering the millions of messages

using artificial-intelligence software,

picking out the ones that could be important,

Justine's army of online volunteers got to work.

Anyone, wherever they're sitting, whatever age,

can contribute to disaster relief.

So how do they go about doing that?

They can sit there with their mobile phone, their laptop

and click on buttons.

You have at the top, "How much damage do you see in this picture?

"None, mild, severe."

-Well, obviously, severe.

-It's severe.

That picture will go through three to five different people

to ensure you get the same answer.

So when you have a text one, what does this tweet refer to?

Not relevant, is it a retweet, is it a request for help,

infrastructure damage?

By pinpointing exactly where in the Philippines

the tweets and pictures had been sent from,

the volunteers created an online map,

not just of the disaster zone but of the needs in each area.

Exactly how much of an impact

has this had on aid workers on the ground?

This...saves...lives.

Rather than them actually starting from scratch

when they arrive in the country,

we can have the information already for them -

who needs water, who needs food, where there were dead bodies,

displacement, damage, hospital damage, everything.

How does it feel to be sitting in your kitchen on Hayling Island,

knowing that you are, in a very real way,

helping to save lives in the Philippines?

It's a lot of pressure,

but it has to be the most worthwhile thing

I have ever done in my life.

-And have you used the system here in the UK at all or...?

-Oh, yes!

We recently have had the bad weather,

like everyone else in the country, with a lot of rain,

so I actually produced our own flood map for Hayling Island.

This is so...clever and so useful.

This is really inspiring stuff

and an example of the incredible things

we humans can achieve when we work together.

By getting involved in this invaluable sharing of information,

we can all effectively play a part in humanitarian aid.

Whether it's a hurricane in the Philippines

or a bomb attack in London,

getting the right resources to the right place fast is vital,

especially when it comes to medical help.

In the immediate aftermath of a disaster,

there's a real need for experts in emergency medicine.

Now, thankfully, here at Zaatari, most of the needs are less acute.

However, nine miles north of here, over the border, there's a war on.

Sadly, the casualty toll in Syria is still mounting.

As in any war, the strange truth is that the carnage it creates

leads to significant medical innovation.

Our recent conflicts in Iraq and Afghanistan

have led to advances in trauma care that mean many survive injuries

that would have killed them just a few years ago.

But traumatic injuries don't just happen in warzones.

Here in the UK,

they're the single biggest killer of people aged between one and 40.

So can any of the lessons learnt on the battlefield

be put into use here?

A lot of the trauma innovations that we've brought in

in the military over the last ten years

are now appearing in the NHS.

Because of the volume of trauma that we see,

and the sheer severity of trauma that we see,

we've been able to come back to the NHS

and say, "Actually, these are the things that you really need to do

"to improve your trauma care."

Many of the innovations

relate to the treatment of massive blood loss,

something Lieutenant Colonel Matt Boylan knows all too well.

As an emergency doctor in the military,

he's served in Iraq and Afghanistan.

But he's also part of the Midlands Air Ambulance Service

here in Britain, so he's seen first-hand

just how we're benefiting from the lessons learnt in war.

So, as a consultant in an urban inner-city emergency department,

we see a large amount of penetrating trauma,

particularly stab wounds and gunshot wounds.

Over the last few years, there've been a number of cases

where patients have bled out and died as a result.

We've got various techniques that we've adopted within the military

that we can now employ in our civilian trauma patients

to try and combat this bleeding.

It doesn't matter whether it's an injury from an IED in Afghanistan

or a road-traffic accident in the UK,

the principle is exactly the same.

You need to stop that bleeding as soon as possible,

because it really is life-or-death time.

So this version of a tourniquet

is standard issue to all military personnel in Afghanistan.

And as I tighten it, what I'm doing

is to apply really strong pressure on the arteries in the leg,

and that will stem the flow of blood.

The success of this tourniquet in the military

has led to it becoming an essential part of the kit

on ambulances across the UK.

But it's not always appropriate to apply a tourniquet.

And that's where a really clever substance,

granules made from the ground shells of shrimps, comes in.

Now, if I just drop this into here,

you can see that the really unique thing

is that this can absorb

over ten times its own weight in liquid.

Once poured into wounds,

it can take as little as 30 seconds to form a solid gel.

And you can see how useful that would be

at stemming the flow of blood.

For the patients treated with these techniques,

it can mean the difference between life and death.

One of the cases I've been to recently

involved a young lady who'd lost a lower limb.

We had to apply a tourniquet

and give her resuscitation en route to hospital

and ultimately saved her life.

With battlefield medicine, it's adapt or die.

So it's often at times of war

that our knowledge and understanding around how best to treat casualties

moves faster than at any other.

But it's a sad truth that long after those wars have been won or lost,

it's civilians all over the world

who'll benefit from the lessons learnt on the battlefield.

Whether it's from the spread of disease, injuries or famine,

one thing that's inevitable in most emergency aid situations

is death.

For the families of those killed,

knowing what's happened to their loved ones

and giving them a proper burial is crucial.

But in the chaos of disaster zones,

the needs of the living are often eclipsed by the fear of the dead.

One of the biggest misconceptions during a disaster

is that dead bodies spread disease.

It's an idea that's often circulated by the media,

by aid workers, and even by local authorities.

But the reality is that, even on a mass scale,

the bodies themselves don't pose an immediate threat.

So why does this myth prevail?

Dead bodies don't spread disease.

The living people spread disease, the lack of sanitation,

the breakdown of infrastructure in a disaster zone spread disease.

Bacteria, like most things, needs life.

A dead body, by definition, is dead.

A lot of the infections,

a lot of the disease needs the hosts to be alive to survive.

So what does this persisting myth lead to on the ground

-when a disaster has just happened?

-Let me give you an example.

I went to Haiti right after the earthquake.

Now, roughly 200...250,000 human beings died in that earthquake.

The Haitian response was to take an area and dig huge pits.

The human remains were loaded into trucks and pushed into the pits.

Taking the dead and burying them to get them out of sight

doesn't stop disease.

It only causes injury to families later on.

So what is the correct way to deal with dead bodies in a disaster zone?

I can really probably show you easier than I can explain to you.

The right to have an identity,

the right to have a name is a human right.

Anyone can bury a body,

but we need to collect information before they're buried.

So what are the main methods used to identify a body?

Simple tools like this.

This is what we use to take a dental X-ray,

and there's a lot that we learn from the teeth.

We can tell age, we can use it to identify

if there's dental work that was done when the person was alive.

-Fingerprints.

-Fingerprints.

A lot of countries still fingerprint people

for driver's license, passports, databases.

And then DNA. Now, DNA is really difficult.

We actually have to cut in and remove a bone sample or two,

and the DNA will survive in the bone and the tooth

much longer than it will survive in tissue.

That's a sobering thought, isn't it?

And this is why all of these different aspects

of the identification process are so hugely valuable.

Absolutely, cos the questions you're going to answer are two things -

did we take care of the dead?

And can we identify them to return an answer to the families?

None of us ever imagine that a war or a natural disaster

could cut the ties to everything that matters most.

But what I've learned here at Zaatari

is that if that were to happen,

there are innovations in humanitarian aid

creating an ever-stronger safety net

to give us the best possible chance of rebuilding our lives.

And that could be any one of us at any time.

Sadly, that's it from Bang for now,

but the website is still up-and-running

with clips and stories from across the series.

And you can follow the links to the Open University

for more information on aid and international development.