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Global assessment of El Niño’s disaster burden
M J Bouma, R S Kovats, S A Goubet, J St H Cox, A Haines
Summary
Background Natural disasters have profound effects on
health and require medical intervention as part of relief
operations. The world’s populations are becoming
increasingly vulnerable to extreme weather events, which
are responsible for most natural disasters. The El Niño
Southern Oscillation (ENSO) is the most prominent global
climate system associated with year-to-year weather
variability and extreme events. We have estimated the
burden on human health of natural disasters associated
with ENSO.
Methods We used time-series regression analysis of the
relation between El Niño years and the annual rates of
persons affected by natural disasters per 1000 population
during 1964–93, globally and also by region and disaster
type. Correlations between sea-surface temperature (SST)
anomalies (index of ENSO) and the rates of persons
affected by natural disasters per 1000 population were
determined globally, by region and by disaster type.
Findings The rate of persons affected by natural disasters
worldwide is strongly associated with ENSO; rates are
greater during the first El Niño year (p=0·05) and the
following year (p=0·01) than in the pre-Niño year. The
correlation between rates of persons affected by natural
disasters and SST anomalies in the Eastern Pacific (a key
ENSO indicator) is highest in the last quarter of the
previous year (r=0·53, p<0·01). These associations are
strongest in South Asia, the region where more than 50%
of all disaster victims live. Worldwide, rates of persons
affected by drought/famine (half of all disaster victims)
and by volcanic eruptions show significant associations
with the ENSO cycle, being highest in the post-Niño year
and El Niño year, respectively, and being significantly
associated with SST anomalies.
Interpretation The strong relation between ENSO and
populations affected by natural disasters can be described
as a “natural disaster cycle”. Determining the phase in this
cycle, using SST from the Eastern Equatorial Pacific, could
benefit disaster preparedness on a global scale, for South
Asia in particular, and for all populations affected by
drought/famine and volcanic disasters.
Lancet 1997; 350: 1435–38
Departments of Infectious and Tropical Diseases (M J Bouma MD,
J St H Cox PhD), and of Epidemiology and Population Health
(R S Kovats MSc), London School of Hygiene and Tropical Medicine;
and Joint Department of Primary Care and Population Sciences,
Royal Free Hospital School of Medicine and University College
London Medical School, London, UK (S A Goubet MSc,
Prof A Haines MD)
Correspondence to: R S Kovats, Department of Epidemiology and
Population Sciences, London School of Hygiene and Tropical
Medicine, Keppel Street, London WC1E 7HT, UK
(e-mail: skovats@lshtm.ac.uk)
Vol 350 • November 15, 1997
Introduction
As we approach the end of the International Decade for
Natural Disaster Reduction, the human and financial toll
of natural disasters continues to rise.1 Some populations
in non-industrialised countries seem increasingly
vulnerable to extreme weather events such as droughts,
floods, and cyclones.2 Global climate change, via changes
in the frequency and intensity of extreme weather events
(and consequent natural disasters), has implications for
health,3 and there is growing interest in the influence of
climatic factors on health. We are learning more about
the nature, impacts, and long-term forecasting of periodic
interannual climate fluctuations, of which the El Niño
Southern Oscillation (ENSO) is the most important.
ENSO is an unstable climate/ocean system which
produces periodic short-term climate changes over the
Pacific, on average every 5 (range 2–7) years. For
centuries, the local effects of El Niño have been
experienced in Peru as a warming of the coastal Pacific,
becoming apparent towards the end of the year, hence the
name Niño (Christ child). This cycle of warming and
cooling of the pacific sea surface, with its two extremes of
El Niño (warm event) and La Niña (cold event), is
closely mirrored by air-pressure deviations between the
East and West Pacific, the Southern Oscillation. Sea-
surface temperatures (SST) in the Eastern Equatorial
Pacific and the Southern Oscillation Index (SOI) are the
two measures of ENSO. Parts of the world which usually
receive less rain during El Niño events tend to become
wetter during La Niña events, and vice versa,4 and ENSO
is also associated with extreme weather events, such as
drought, floods, and storms.5 In this study, we assess the
relation between ENSO and the size of populations
affected by natural disasters.
Methods
Data sources
Data on people affected by natural disasters were obtained from
EM-DAT Disaster Events Database,6 Centre for Epidemiology
on Disasters, University of Louvain, Belgium. The criteria for a
“disaster” are at least 10 deaths and/or 200 people affected
and/or an appeal for outside assistance.6 Data entries are
constantly reviewed for inconsistencies, redundancies, and the
completion of missing data. When information conflicts, priority
is given to data from governments of affected countries and then
to information from the UN Department of Humanitarian
Affairs and the US Office of Foreign Disaster Assistance.
The number affected by a disaster is a more acute indicator of
impact than the number of deaths. The ratio of deaths to
number affected over the past two decades is about 1:900.2 An
“affected” person is defined as someone requiring immediate
assistance (eg, for food, shelter, or medical care) or long-term
assistance as a direct consequence of the disaster (eg, for
housing, agriculture, or infrastructural rehabilitation); deaths are
excluded.6 We analysed the number of people affected by natural
disasters by year (1964–93) by region, and by disaster type. We
used EM-DAT regions but combined western with eastern
Europe. In the analysis by type of disaster, we combined
populations affected by disasters with a similar aetiology.
Hurricanes, typhoons, cyclones, and storms were aggregated
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Persons affected by disaster (per 1000 population

Differences in rates between El Niño, post-Niño, and pre-
80 Niño years were analysed by time-series regression including
Non Niño years dummy variables for El Niño, post-Niño, and other years (the
El Niño years immediate pre-Niño years are the baseline). Untransformed rates
Possible El Niño years are presented in the results; the p values were obtained from
60 time-series analyses on transformed data.

ENSO and SST

The definition of an El Niño year is dependent upon the
40 meteorological criteria used. For 1964–93, consensus supports
six El Niño events, in 1965, 1972–73, 1976, 1982–83 and 1987.8
Of the immature events of 1969, 1979, and 1991, only 1991
developed into a mature event9 so we included that too. We
define the year before an El Niño event as “pre-Niño” and the
20
year after as “post-Niño” year even if it too was an El Niño year
as it was in 1973 and 1983.
Because the determination of an El Niño “year” is open to
debate we also used the ENSO indicator of seasonal SST
0 anomalies in the Eastern Equatorial Pacific (from 20°N to 20°S
19

19

19

19

19

19 and from 170°E to the coast of the Americas).10 This variable

65

70

75

80

85

90
covers the years between ENSO extremes. Data on seasonal SST
Year
anomalies (ie, deviations from the average for 1961–90) were
Figure 1: Rate of persons affected by natural disasters per
obtained from the UK Meteorological Office. We examined the
1000 world population during 1964–93
relation between seasonal average SST anomaly and rates for
Continuous line represents predicted values from time-series regression.
persons affected per 1000 in the same year and, since the
under “storms” and drought, food shortage and famine were implications for world weather often lag behind ENSO events in
combined under “drought’. the Pacific, the relation between rates and SST anomalies in the
previous year. Correlations were adjusted for autocorrelation of
Analysis SST anomalies.11
Disasters such as epidemics, and insect infestations, contribute
little to the global burden and were not individually investigated. Results
Descriptive statistics only are given for landslides and heatwaves
because of their infrequent occurrence in the database.
The total number of disaster-affected people and global
Rates of persons affected by natural disasters per 1000 rates over the three decades 1964–93 both show
population (PAD rates) were calculated using United Nations considerable interannual variation and a rising trend
population data.7 Global, regional, and disaster-type rates were (figure 1). All El Niño years, except for 1976, appear
not normally distributed and were transformed. Data series for associated with increased rates for persons affected per
the world and for sub-Saharan Africa*, North Africa*, Central 1000 population. Figure 2 shows global rates (deviation
America, the Caribbean*, and Europe, and for floods*, storms*, for trend) during the year(s) of and in years surrounding
earthquakes, and volcanoes were square-root transformed. Data the six El Niño events. For the first two ENSO events
series for South America, Oceania*, South Asia, and South East rates were 13–20 times higher in post-Niño years
Asia and for droughts were log-transformed. North America*,
(3–10-fold increase). The difference in rates between pre-
East Asia*, and West Asia series were ranked. After
transformation, if statistically significant, a linear trend was Niño and post-Niño years is about 27 per 1000 or 2·7%
subtracted from each of the series; only the global series and of the world population. Time-series regression shows
those disaggregated series marked (*) showed significant trends. that rates were significantly higher during the six El Niño
and post-Niño years than in the pre-Niño years (p=0·05
Persons affected by disaster (per 1000 population)

and p=0·01, respectively) (table 1).

Analysis of the annual global rates for persons affected
50 65 87 per 1000 revealed significant correlations with seasonal
72 91 SST anomalies in the last two quarters (July to
40 76 Average September, r=0·44, p<0·03; October to December,
(deviations from trend)

82
30 r=0·53, p<0·01) of the previous year and the first quarter
20 80
Persons affected by disaster
(per 1000 population)

10
60
0
–10
40
–20
–30 20
Pre-pre- Pre-Niño El Niño Post-Niño Post-
Niño post-Niño
0
Figure 2: ENSO-related disaster cycle
Deviations from detrended global rates of disaster-affected persons per –1·5 –1·0 –0·5 0 0·5 1·0 1·5
1000 population during the six El Niño events between 1964 and 1993,
and two years before (pre-pre-Niño years) and two years after (post-post- SST anomalies (Oct-Dec, previous year)
Niño years). Bars represent mean deviation for all six events. Deviations Figure 3: Scatter plot of global rates of persons affected by
from trend are differences between observed and predicted values; natural disasters per 1000 population and SST anomalies in
predicted values are squared from time series regression. For 1974 and
1989 the first and the last year in the depicted cycle overlap and these last quarter (Oct–Dec) of previous year
data are shown only in the last bar (post-post-Niño year). Regression line is quadratic in form y=19·5+20·5x+8·9 x2..

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World Sub- North Central South Carib- North Oceania Europe East South South West
Saharan Africa America America bean America Asia Asia East Asia
Africa Asia
Average PAD rates 22·9 22·0 0·71 3·0 14·2 12·0 0·05 6·93 0·73 15·3 67·0 12·2 1·64
(all years)
Average total per year 106·9 9·09 0·07 0·27 3·29 0·36 0·01 0·18 0·51 20·5 67·9 4·57 0·16
(millions)
Average PAD rates (range)
Pre-Niño 8·06 10·87 0·39 3·76 5·89 3·07 0·00 3·90 0·45 11·1 13·44 8·01 4··83
(2·44– (3–28·2) (0–1·6) (0–10·8) (0·3– (0–8·6) (0–0) (0·3– (0·1–1·6) (0–50·6) (6–30·5) (0·3– (0–28·2)
20·24 14·5) 12·7) 22·7)
El Niño 34·66 20·94 0·26 3·53 5·99 3·21 0·03 3·14 1·16 31·6 101·15 12·19 1·65
(3·52– (2·8– (0–1·1) (0–7·1) (1·4– (0·1–7) (0–0·1) (0·5–6) 0–5·1) (0·3– (6·1– (3·3– (0–8·3)
74·48)* 41·2) 17·2) 181·4) 303·5) 38·7)
Post-Niño 35·19 33·58 0·40 3·30 32·55 27·94 0·01 5·12 0·99 12·8 117·08 12·33 0·08
(5·67– (0·6– (0–1·4) (0·6– (0– (0·1– (0–0·01) (0·4–20) (0–2·5) (0–57·5) (8·7– (5·3– (0–0·3)
61·23)‡ 76·1) 6·2) 132·5) 90·4) 242·6)† 25·7)
Correlation with SST (r) 0·53 0·39 0·31 0·11 0·11 0·37 ⫺0·26 0·36 0·39 ⫺0·28 0·52 0·17 0·29
(0·15– (0·004– (⫺0·07 to (⫺0·25 to (⫺0·26 to (⫺0·004 (⫺0·58 to (0·01– (0·01– (⫺0·58 to (0·14– (⫺0·20 to (⫺0·59 to
0·78)‡ 0·67)* +0·61) +0·45) +0·45) to 0·65) +0·11) 0·65) 0·67) +0·10) 0·77)‡ +0·49) +-0·09)
Highest seasonal correlation 4, P 3, P 1, S 2, S 1, P 2, S 1, P 2, S 4, P 4, P 4, P 1, S 1, S
Season 1=Jan–March, season 2=April–June, &c. P=previous year, S=same year.*p=0·05, †p=0·04, ‡p=0·01 (by comparison with pre-Niño for PAD rates).
Table 1: Time-series analysis of PAD rates (persons affected by disaster per 1000 population) by region in El Niño and post-Niño
years compared with pre-Niño years, and correlation with SST anomalies, 1964–93

Drought Flood Earthquake Storm Volcano Heatwave Landslide

Average no per PAD rate 11·84 8·44 0·33 1·83 0·02 0·34 0·06
(all years)
Average total n per year (millions) 53·24 41·07 1·51 8·66 0·08 1·73 0·24
Average PAD rates (range)
Pre-Niño 1·14 (0·07–2·98) 5·03 0·19 1·62 0·001 (0–0·004) 0·0 0·004
El Niño 19·37 (0–62·90) 12·68 0·33 2·13 0·046 (0–0·14)‡ 0·00001 0·003
Post-Niño 25·84 (2·16–55·95)* 4·83 0·79 1·75 0·017 (0·001–0·07) 2·49 0·36
Correlation with SST (r) 0·66 0·23 0·05 ⫺0·19 0·55* .. ..
(0·28–0·86)† (⫺0·14 to +0·55) (0·31–0·40) (⫺0·51 to +0·19) (0·18–0·79)
Highest seasonal correlation Oct–Dec prev yr Jan–Mar prev yr Jul–Sep prev yr Jul–Sep prev yr Apr–Jun same yr .. ..
Numbers given are raw data but statistical tests done on transformed data (see text). Drought includes famine and food shortages; storm includes cyclones, hurricanes, and
typhoons; heatwave and landslide=insufficient data for analysis.*p=0·01, †p=0·003, ‡p=0·006.
Table 2: Time series analysis of PAD rates in El Niño and post-Niño years compared with pre-Niño years and correlation with SST
anomalies, by type of disaster, 1964–93

of the same year (r=0·46, p<0·02). High positive SST
anomalies in last quarter of the previous year appear
most strongly associated with rates in the following year
(figure 3). Below-average SST (negative SST anomalies)
are mostly associated with a low rate for persons affected,
whereas high SST anomalies (El Niño and post-Niño
years) are associated with high rates.
The areas with the highest annual average number of
affected people in 1964–93 were South Asia (67·9
million), East Asia (20·5 million), and sub-Saharan Africa
(9·09 million). These regions also had the highest annual
average number of people affected per 1000 population
(67, 15·3, and 22, respectively). The least disaster-prone
populations are in North America, North Africa, and
Europe.
Time-series regression comparing El Niño, post-Niño,
and other years with pre-Niño years in different regions
showed that PAD rates are significantly higher during
post-Niño years in the Caribbean (p<0·05) and South
Asia (p<0·04). In sub-Saharan Africa, differences
between pre- and post-Niño years are considerable but
not significant (p=0·09). In seven of the twelve regions,
the rate is highest during post-Niño years. Correlations of
SST anomalies with rates of persons affected per 1000
were significant for sub-Saharan Africa (r=0·39, p=0·05),
Europe (r=0·39, p=0·05), and South Asia (r=0·52,
p=0·01; table 1). The region with the highest absolute
numbers and rates (South Asia) also shows the strongest
association with ENSO. However, caution is needed in
interpreting the data for each region because of the risk of
spurious associations involved in using multiple statistical
tests.
Drought (including food shortage and famine) accounts
for around half the world’s annual disaster victims and
shows significant associations with post-Niño years and
SST anomalies (table 2). Drought is the principal cause
of disaster in sub-Saharan Africa, South America, and in
South and West Asia (not shown). Rates for volcanic
disasters also show significant associations in time-series
regression with El Niño years and SST anomalies.
Discussion
Our analyses show that the number of people requiring
assistance as a result of natural disasters increases during
El Niño years and in the year following, and this
observation is supported by the strongly positive
correlation between SST anomalies in the last quarter of a
year and rates per 1000 for persons affected in the
following year.
Data relating to emergency situations, often from
countries with poorly developed information systems, will
contain many inaccuracies. Some of the observed trend in
persons affected by disasters is likely to be due to
improved reporting but populations have also become
increasingly vulnerable to disasters.6 Furthermore, we
used regional estimates of population and such aggregates

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may not accurately reflect growth rates in populations
where the impact of disasters is felt most strongly.
Nevertheless, such inaccuracies are unlikely to be
responsible for the associations described since there is no
reason why either information quality or population size
should vary according to the climatic cycle of ENSO.
Each El Niño event has unique features. The finding
that the global signal of ENSO in the disaster figures is
more pronounced than for any of the regions individually
may be explained by the variability in geographical
regions affected by the El Niño event. A longer time series
and disaggregation of regional data are required for
further elucidation of regional differences. Drought,
including food shortage and famine, was responsible for
half the global disaster-affected population between 1964
and 1993 and shows the strongest association with
ENSO. Dilley and Heyman12 found that disasters
triggered by drought are twice as frequent during El Niño
years as in other years, and our analysis by rates of
persons affected supports that finding. For reasons not
well understood, volcanic eruptions are associated with
ENSO,13 and we too found that more people are affected
by volcanic disasters during El Niño events.
The importance of ENSO in determining the burden of
natural disasters on populations suggests ways for
improving disaster management and related public-health
issues.14 Particularly in South Asia, ENSO forecasts may
assist regional disaster preparedness, and for drought
there is the opportunity for forecasting on a global scale.
Our global and regional analyses may mask important
local effects of ENSO. For example, in a typical El Niño
year, tropical cyclone activity increases in the Marshall
Islands (in the Pacific) but decreases in the Atlantic
basin,15,16 and some areas have an increased risk and
others a decreased risk of malaria epidemics.17,18 This
reinforces the need for the effects of ENSO on health to
be assessed with higher temporal and spatial resolution.
Much progress is being made in agriculture with the use
of ENSO forecasts to improve crop yields19 and provide
early warning of famine in Africa.20 Although an El Niño
has often been identified only in the December before an
El Niño year, forecasting skills are improving and the lead
time now extends to 3–6 months.21 The global trend to
increased vulnerability to disasters demands improved
early-warning systems and more rapid and appropriate
responses.22 1997 is an El Niño years23 and this adds
urgency to the quest for better understanding of the links
between ENSO, natural disasters, and health.
Contributors
All authors contributed to the methodology, acquisition of data, and
writing of the paper. M J Bouma and S A Goubet undertook the statistical
analyses.
Acknowledgments
We thank Claudine Misson (University of Louvain) for advice about the
1438
EM-DAT database. EM-DAT is supported by the International
Federation of Red Cross and Red Crescent Societies, the World
Meteorological Organization, and the European Union Humanitarian
Office.
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