Introduction

It has been estimated that, each year between 1990 and 1999, an average of 188 million people worldwide were affected by disaster, six times more than the average of 31 million people affected annually by conflict (International Strategy for Disaster Reduction, 2005). These figures for disasters do not include estimates for smaller disasters that typically are under-reported. Of particular concern around the world is that weather-related disasters have increased over the past decade, as evidenced by the devastating hurricanes across the Gulf Coast in the United States. Along with natural disasters, the possibility of Weapons of Mass Destruction (WMD) terrorism places significant numbers of children and families at enormous risk for psychosocial morbidity, and places extreme demands on shelters, schools, primary care settings, health and mental health care facilities, as well as federal, state and local agencies and organizations that play a role in coordinating or participating in disaster response. Children have unique risks from WMDs due to various physiological and psychological factors, including susceptibility to radiation, propensity to become hypothermic from mass decontamination, inadequate availability of pediatric emergency care and equipment, contraindications for pediatric use of standard treatments, and possible greater risk from the biological agents themselves (Pynoos et al., 2005a). Pandemic flu represents another type of catastrophic scenario, with special mental health aspects for children and families, including issues of potential quarantine for long periods.

To date, there are no reliable large-scale epidemiological data on the morbidity or mortality of children exposed to terrorism and disaster.