After an earthquake: understanding injuries, crush syndrome and the health risks that follow

What injuries are most common after an earthquake?

Earthquakes produce a recognisable pattern of injuries that differs from road traffic accidents or burns. Fractures of all kinds are most frequent, followed by lacerations from glass and structural debris. Head, chest and abdominal injuries occur when ceilings and walls collapse directly onto people. Limb crush injuries from heavy falling debris can require amputation in the most severe cases.

A study published in Medical Science Monitor in 2024, covering 377 patients from the February 2023 Turkiye-Syria earthquake, found that the median time of rescue from rubble was approximately 20 hours. The severity of injury correlated directly with the duration of entrapment. Lower limb injuries were present in 60% of cases, making them the most common anatomical site affected.

Children show a somewhat different injury profile. Research focused on paediatric cases from the 2023 earthquake, published in Pediatric Nephrology, found that children are less vulnerable to the most severe form of crush syndrome than adults because of their smaller muscle mass, but they are more prone to severe dehydration and malnutrition during extended waiting periods under rubble. This distinction matters for triage and for the type of intravenous fluid support they need on rescue.

Crush syndrome: why it kills after rescue

Crush syndrome is the most dangerous medical complication specific to earthquake survivors, and it is fundamentally different from visible injury. When a large muscle group remains compressed under debris for more than four hours, muscle cells begin to die and release a protein called myoglobin into the bloodstream. Myoglobin is toxic to the kidneys and blocks the delicate tubules that filter the blood.

The greatest danger occurs after rescue, not before. When pressure is released from a crushed limb, myoglobin and accumulated fluid surge suddenly into the general circulation. Blood pressure drops sharply and the kidneys face a double assault. This moment is called reperfusion injury, and without prior medical preparation it can be fatal even in someone who was alert and speaking moments before.

In the retrospective study of 377 patients by Kurt and colleagues, more than 50% of crush syndrome patients developed acute kidney injury, and a large proportion required temporary dialysis. The mortality rate reached approximately 16% despite hospital-level care. That figure illustrates how dangerous this condition is even with treatment, and why rapid transfer to a facility with renal support is the single most important intervention.

Wound infections and tetanus: why a minor cut is not minor

Wounds from earthquake debris are different from ordinary lacerations. Concrete dust, contaminated soil, rotting wood and corroded metal all raise the infection risk substantially. A study in Pediatric Surgery International published in 2024, which analysed wounds in children after the 2023 earthquake, found that over 20% of wounds progressed to local or systemic infection despite receiving initial care at hospital. This rate underscores how highly contaminated earthquake wound environments are.

Tetanus is the principal danger from soil-contaminated wounds. The causative bacterium lives in soil and multiplies in low-oxygen environments such as deep puncture wounds. The tetanus vaccine provides reliable protection when up to date. Anyone who has not received a booster in the past ten years, or whose vaccination history is incomplete, needs a dose as soon as possible after any open wound sustained in earthquake rubble.

To clean a wound in resource-limited conditions: irrigate it with a generous volume of clean water or boiled water that has been allowed to cool, pressing firmly to flush debris and soil out. Do not apply soil, honey or any traditional remedy to the wound. These practices are common in the region but increase infection risk and make medical assessment harder. Cover the wound with a clean dressing and reach a medical post as quickly as possible for proper evaluation and tetanus status review.

Water and food safety after an earthquake

Earthquakes crack sewage pipes and water mains simultaneously, making contamination of drinking water with sewage common in the immediate aftermath. Cholera, typhoid, bacterial diarrhoea and viral gastroenteritis all spread through contaminated water. The basic rule is: do not drink tap water until authorities issue an official confirmation that it is safe.

A scientific review published in Microorganisms in 2023 on infectious disease after disasters found that post-earthquake disease outbreaks rise sharply when toilets and water sources become cross-contaminated, as occurred in several historical earthquakes. Areas with already fragile infrastructure before the earthquake are most vulnerable to waterborne outbreaks in the days that follow.

To purify water in emergency conditions: boiling for one full minute (three minutes at altitudes above 2000 metres) is the most reliable method. If boiling is not possible, adding household bleach at the correct concentration is effective against most bacterial and viral pathogens, though not against all parasites. Check with any field health organisation for sources of certified safe water in your specific area.

Chronic conditions in a disaster

A person with diabetes, hypertension, heart disease or epilepsy faces compounded risks during an earthquake. Acute stress raises blood pressure and blood glucose significantly. A break in medication for even a few days can trigger crises that require resuscitation. Loss of monitoring equipment such as a glucose meter or blood pressure cuff removes the ability to track the condition.

At any field medical centre you reach, the first thing you should do is tell the staff about your chronic conditions and the names of your usual medications. Organised field facilities typically stock reserves of essential drugs including insulin, antihypertensives and antiepileptics. Early contact with a field medical centre can be as life-saving for someone with a chronic disease as it is for someone with a traumatic injury.

Insulin users face an additional challenge. Insulin loses its effectiveness when exposed to extreme heat. Insulin stored in a car under direct sun or inside a hot tent may become inactive without any visible change in appearance. If you use insulin and your blood glucose is not responding to your usual dose in post-earthquake conditions, alert a field doctor immediately, as the most likely explanation is heat-degraded insulin.

Dialysis patients represent a critical priority in any earthquake response. Dialysis machines depend on continuous electricity, sterile water supplies and trained staff. If you know of a dialysis patient in a disaster-affected area, report them to medical teams as an urgent priority. Missing even one scheduled session puts the patient's life at immediate risk from electrolyte accumulation and fluid overload.

Health risks in temporary shelters

Temporary shelters concentrate large numbers of people in poorly ventilated spaces, creating near-ideal conditions for the spread of respiratory infections such as pneumonia, measles and whooping cough. Crowding combined with inadequate sanitation exposes everyone to enteric disease. Insects, particularly mosquitoes, lice and scabies mites, spread rapidly in shelter environments.

Core prevention principles in temporary shelter: wash hands with soap before eating and after using the toilet; sleep under a mosquito net where available; avoid sharing personal items such as towels and cups; change and wash clothing regularly. Report any respiratory illness within your tent or shelter area to the health team immediately so that appropriate isolation can be arranged before an infection spreads to the wider population.

Measles in particular spreads explosively in crowded settings. If children in the shelter have not been vaccinated, ask about emergency measles vaccination as a priority. Health organisations responding to major earthquakes typically include measles vaccine in their first-response supplies, and even a single dose provides substantial protection.

Scabies spreads through direct skin contact and shared bedding or clothing. The main symptoms are intense itch that worsens at night and a rash between the fingers, on the wrists and around the waist. Treatment is effective but must be applied to every member of the household simultaneously or re-infection follows immediately. Report any suspected case to the medical team rather than treating it privately and incompletely.

Mental health after an earthquake: what is normal and what needs care

An earthquake is a traumatic experience in every sense. It is sudden, violent, and it strikes the place where people feel safest. The immediate psychological response includes panic, disbelief and emotional numbness, all of which are normal reactions rather than signs of a mental health disorder. In the first days, psychological and physical energy is focused on survival, and the absence of obvious emotional response should not be interpreted as pathological.

In the weeks that follow, more persistent symptoms may emerge: repeated nightmares of earthquake scenes, a startle response to any sudden noise, difficulty concentrating, and a persistent sense of danger even in objectively safe surroundings. These are symptoms of post-traumatic stress disorder and they respond well to specialist psychological treatment. Early intervention gives the best outcomes.

In children who witnessed the earthquake, watch for regression in already-acquired skills such as speech or bladder control, excessive fear of darkness or loud sounds, refusal to sleep alone, and repeated physical complaints without an organic cause. These are trauma signs that respond well to early intervention, consistent routine and honest reassurance. Avoid dismissing or minimising what the child experienced.

Grief for what has been lost, whether a home, belongings or loved ones, is a legitimate and healthy response and is not in itself a disorder. The problem arises when painful symptoms persist for weeks and prevent the person from recovering basic function. At that point, seeking psychological help is not an admission of weakness. It is an investment in the capacity to rebuild.

Using the Sihtak app in an emergency

In the chaos that follows an earthquake, most people lose their medical documents. The Sihtak app allows you to store your medical history, test results and medication list in one place on your phone that any field doctor can access quickly. In emergency conditions, the ability to say with documented certainty what conditions you have and what medicines you take at what dose is a practical tool that directly affects the care you receive.

Sources

• Kurt et al., A Retrospective Study of 377 Patients with Crush Syndrome After the Turkiye-Syria Earthquakes, Medical Science Monitor, 2024
• Doven et al., The 2023 Turkiye-Syria earthquakes: pediatric victims with crush syndrome and acute kidney injury, Pediatric Nephrology, 2024
• Yesil et al., Analysis of wound infections among pediatric patients following the 2023 Turkiye-Syria earthquakes, Pediatric Surgery International, 2024
• Mavrouli et al., The Impact of Earthquakes on Public Health: Infectious Diseases in the Post-Disaster Period, Microorganisms, 2023
• World Health Organization: Emergency preparedness and response, crush injury and crush syndrome, WHO 2002
• Narrative review: tetanus after natural disasters in developing countries, PubMed, 2011