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Technological advances that have allowed even the remotest corners of the globe to be almost instantly accessible, mean that the evolution and resolution of recent disasters, massive destruction and untold human distress, can be followed anywhere in real time. We are regularly presented with images of disasters where governments seem caught off guard, confused, overwhelmed and finally, forced to seek international assistance in saving lives and organizing relief. After over 25 years of applied research by academics, promotion of best practice by disaster management experts, not to mention funding for disaster management agencies and institutions, are governments really still unable to respond coherently to natural disasters? Or does the information we get not accurately reflect what is actually happening?

The media and disaster management agencies need each other to perform their functions better. Information needs to be presented responsibly.

The international media no longer simply reports what has happened and what is being done. It analyzes what is not being done and prescribes what should be done. This extends the role assumed by the western media in domestic issues, where scrutinizing public officials' performance is well accepted, and institutions to punish, protect or compensate exist. In international reporting, this may be neither fair nor appropriate, as the subjects have no redress if misrepresented and no protection if wronged. Conversely, international media agencies risk no penalties should they act unethically when reporting from non-western countries. In disasters, the international media often define needs and assign priorities that are inconsistent with those of affected populations. Reported opinions are given by people who are ill-informed because they lack knowledge of local cultures and contexts (foreign experts), have specific agenda (international NGOs and local interest groups exaggerating the severity of problems to maximize fundraising), or are unqualified (news agency reporters or government officials) to analyze and offer prescriptions.

From a public health perspective, the reporting of recent disasters has highlighted two areas where the public are given misleading or inaccurate information: that epidemics and exotic diseases are inevitable consequences of disaster, and that dead bodies cause epidemics. In times past, natural disasters were often followed by epidemics because of substandard health care and unhygienic living conditions, rather than any causal relationship between disaster and disease. Since World War II, it has been uncommon for natural disasters to be followed by communicable disease outbreaks. Improvements in urban living conditions, and worldwide adoption of primary health care approaches to service delivery, mean that people are healthier, living conditions cleaner and health systems can quickly detect and deal with disease outbreaks. One of the last epidemics occurring after a natural disaster was malaria in Jamaica after hurricane Flora in 1963. Since then, no epidemics have followed natural disasters, despite their occurence in other circumstances, because governments, and increasingly non-government organizations, routinely strengthen disease surveillance systems. There are always increased cases of common diseases after a disaster but even in the poorest countries, these can be managed aggressively. Similarly, a belief persists that exotic diseases such as plague or Ebola will occur after a disaster. Exotic diseases, like any other, must be transmitted and naturally present in a particular geographical area before they can be. After a disaster, they will not appear in a community unless they are already present, therefore posing little risk to most disaster victims. Despite these facts, after every natural disaster, the international and local media routinely predict that an epidemic will occur and speculate that it could be a disease that has never been recorded in the communities affected. The second commonly propagated myth is that corpses are sources of disease. Although infectious diseases can be caught from decomposing bodies, there has never been a disease outbreak attributed to not disposing of bodies of people killed in a natural disaster. Even under desperate circumstances, people avoid contact with corpses. For a disease to spread quickly, the infected source needs to come into close contact with many people in a short time, and each of those needs to contact many others. This contact "tree" needs to grow for many days before an epidemic can sustain itself. The outbreak will end if the chain is interrupted or if not enough new contacts are made to maintain momentum. Whatever happens, there is time for good public health surveillance systems to detect early cases and respond appropriately. Since dead bodies are immobile, they cannot cause enough new cases each day to sustain an outbreak, no matter how many there are. In disasters, the message is that common diseases occur commonly and it is survivors without clean water or sanitation facilities who spread disease among each other. Recently we have seen governments responding to media pressure by diverting precious resources to retrieving dead bodies, when there were still survivors without drinking water, sanitation and shelter. The retrieval and care of the dead is important in disaster management, and should be done with sensitivity and respect for cultural and social values, but it is not a public health priority, and should only be done once arrangements for survivors' basic needs are in place. The media and disaster management agencies have important roles to play in crises. Each needs the other in order to perform its function better. Information needs to be presented responsibly, with contextual understanding. Disaster management agencies must be transparent and cooperative, to ensure that credit is given for achievements and that mistakes are recognized and corrected. If there is to be collaboration between the media and disaster management agencies, then regular dialogues are needed, both during disasters and at other times. Only then will each believe that the other is doing its job. --Dr. Rodger Doran Dr. Rodger Doran is a private consultant based in Bangkok. After training in tropical medicine and public health in London, he spent seven years working in conflict areas with NGOs and the UNHCR, before joining the emergency division of WHO in Geneva in 1992. Since 1997, he has been working for various international agencies and academic institutions, including ADPC, with an interest in public health in the context of disasters and refugees.