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Emergency shelters and other necessary support are provided by governmental agencies and nongovernmental agencies to masses of individuals in need of temporary safe housing, food, clean and adequate bathroom facilities, and medical care during times of disasters. Unfortunately, in some instances such as in Hurricane Katrina, poor planning and poor decision-making created huge numbers of problems. The shelters were inadequate to house the large numbers of people who had to be evacuated from highly dangerous areas. The shelters would not accept pets and since there was no provision for pet evacuation, many older people refused to leave their homes resulting in unneeded deaths. There was inadequate transportation to get people out of dangerous areas and into safe facilities. Shelters of last resort such as the Superdome and New Orleans Convention Centre did not have sufficient capacity, equipment, or supplies. There was a total lack of organization within the Superdome, and it was very difficult for the police and military to control the masses of people. There was no compiled list available showing all shelters. There were extreme problems of lack of adequate clean and equipped sanitary facilities. The opportunities for crime were rampant. There was poor record keeping and it was difficult to determine who was in what shelter and how they could be reached. The removal of individuals to more permanent housing was complicated by numerous factors including a lack of safe facilities that could be moved to the vicinity of the disaster area. The enormity of the discussion of these problems is beyond the scope of this book. (See endnote 58.)

Of major concern is the potential for infections spreading in an overcrowded special area where large numbers of people who have been displaced are seeking shelter. The people arriving are in various stages of health or sickness, acute and/or chronic. They are of all ages. They have all levels of susceptibility to disease and probably all levels of immunizations including no protection necessary to prevent certain diseases. This complex group of people, who are under extreme stress thereby lowering their ability to resist disease, may spread microorganisms through the enclosed air of the facility, in water, food, fecal matter, bedding, and other inanimate objects including toys, and by personal contact especially by contaminated hands. In the past, some of the worst epidemics were caused by this type of situation and therefore great precautions need to be taken to prevent the addition of these burdens to all of the problems caused by the disaster.

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