• Even after a hurricane has passed, people returning to the area are at risk of a number of physical and mental health problems.
  • Contaminated floodwater and mold exposure during cleanup can be dangerous in the short term.
  • In the long term, survivors of severe storms can face mental health issues.

A re-energized Hurricane Dorian is making its way up the Southeastern U.S. coast, knocking out power and flooding areas with storm surges.

The torrential winds and rain have already caused injuries and destruction — with at least 20 people dead in the Bahamas and so far two deaths reported in Florida and North Carolina.

While newscasters turn to the U.S. to follow the storm, the survivors in the Bahamas will face health challenges in the coming weeks, months, and years. After the hurricane moves on, residents face dangerous physical and mental health problems while cleaning up the rubble.

Floodwater left behind after a hurricane can be deceptive.

It may contain raw sewage, household and industrial chemicals, or other hazardous substances. Exposure to these can cause symptoms such as upset stomach, intestinal problems, skin rash, wound infections, tetanus, or flu-like symptoms.

These substances may be present in standing water, household wells, or on objects that have been submerged.

Floodwater can also hide sharp metal or glass, submerged power lines, or strong currents.

“It actually takes very little floodwater to sweep away a pedestrian or even a car,” said Jennifer Horney, PhD, MPH, a professor and director of epidemiology at the University of Delaware in Newark.

According to the Centers for Disease Control and Prevention (CDC), the best way to protect yourself is to stay out of floodwater.

If you do come in contact with the water or potentially contaminated objects, wash the area of your body with soap and clean water, or alcohol-based sanitizer or wipes, as soon as possible.

Discard food, beverages, and prescription drugs that have come into contact with floodwater. Wash clothing and other objects with hot water and soap before reusing them.

People may also run into problems when they return home and begin to clean up their homes and property.

Chris Uejio, PhD, assistant professor of geography at Florida State University in Tallahassee, said in the immediate days after a hurricane that people are at risk of electrocution from downed power lines and carbon monoxide poisoning from electrical generators.

Injuries during cleanup are also common, such as from falling objects, power tools, or overexertion while removing waterlogged furniture or drywall.

People with chronic health conditions such as asthma, heart disease, or diabetes may see a worsening of their condition from the extra physical effort.

Horney said these conditions can be exacerbated if people don’t have access to their prescription drugs or medical equipment.

Mold can also be a problem after a hurricane, especially in warm locations like the Southeastern United States. Exposure to mold can worsen asthma or trigger allergies.

The CDC offers tips for cleaning up safely after a hurricane and preventing the growth of mold.

Upper respiratory infections are common in people staying in shelters during and after a hurricane. It can bring symptoms like cough and runny nose.

The large amounts of standing water after a hurricane also provide a perfect breeding ground for mosquitoes, some of which may carry diseases such as Zika or West Nile.

Scientists found an increase in West Nile in areas affected by Hurricane Katrina in 2005.

“One thing that public health departments do after the waters or storm surge recedes is spray for mosquitoes to try to prevent Zika or other mosquito-borne diseases,” said Horney.

Bites from other creatures can also be a problem after a hurricane, including from other insects, spiders, reptiles, wild animals, and even displaced household pets.

To prevent insect bites, the CDC recommends that people use an insect repellant with DEET, picaridin, or another product approved by the Environmental Protection Agency.

Mental health conditions such as anxiety, sleep disruption, and post-traumatic stress disorder (PTSD) can occur in people who have been through a hurricane.

Uejio said the impact of a natural disaster on a person’s mental health depends on a number of factors, including what they went through during the event.

A person’s coping mechanisms, social networks, and monetary resources can also impact how quickly a person can start to “process the event.”

A person’s PTSD can be re-triggered “by other stressful events or even when another hurricane makes the national news,” said Uejio.

The U.S. Department of Health and Human Services has a Disaster Distress Helpline which provides crisis counseling and support to people during and after a natural or human-caused disaster. A trained crisis counselor can be reached 24/7 by calling 800-985-5990 or by texting TalkWithUs to 66746.

Horney said some of these health problems can be prevented or minimized by preparing in advance — such as by stocking up on food, water, and medications, leaving the area when evacuation orders are given, and listening for government alerts both during and after the storm.

She adds that with powerful storms occurring more frequently in recent years, people shouldn’t prepare for the last storm — they should prepare for the next one, which might be even worse.

“People have to think about how to adapt their preparedness actions based on the types of storms we’re seeing now,” said Horney.