Managing Earthquake Debris: Environmental Issues, Health Impacts, and Risk Reduction Measures

Abstract

Earthquakes have the potential to cause severe and widespread structural damage to buildings and infrastructure in the affected area. Earthquake debris mainly results from building collapses during intense ground motion and the emergency demolition of damaged and unstable buildings following a devastating earthquake. Debris management constitutes a major challenge that must be met by all those participating in disaster management as it poses threats to both the natural environment and public health in an earthquake-affected area. This narrative review examines the hazards that arise throughout the early phases of debris removal, when personnel operate in disaster-affected areas, to the last steps of sorting and disposal. Furthermore, emphasis is also given to the environmental impact caused by unregulated debris disposal on natural habitats that are highly sensitive and susceptible to hazardous substances and materials found in the debris. In the same framework, measures are proposed for alleviating the negative impacts of debris management on the well-being of all individuals involved, including workers, volunteers, and the local community, as well as the surrounding natural environment, encompassing soil, surface and groundwater, as well as air quality.

1. Introduction

Earthquake debris results mainly from collapsed structures during the shaking of the ground and the immediate removal of severely damaged and unstable buildings following an earthquake [1,2,3,4] (

Table 1. Main categories of earthquake debris. Related information is provided by Brown et al. [1], Brown [3], and Dugar et al. [4].

Main Categories of Earthquake Debris	Elements of Earthquake Debris Categories
Municipal solid waste	Personal property and general household trash
White appliances	Freezers, refrigerators, washers/dryers, cookers, air conditioners, ovens, water heaters, dishwashers, etc.
Earthquake debris from buildings, roads, and bridges	Concrete, metals, bricks, asphalt, stones, wood, roof tiles, etc.
Electronic waste	Televisions, computers, monitors, sound and audio devices, printers, telephones, etc.
Vehicles and vessels	Cars, trucks, and boats together with equipment for their maintenance (tires, plastic parts, etc.) and fuels to generate motion (petrol, diesel, and batteries)
Household hazardous waste	Automobile batteries, motor oil, paints and solvents, pesticides, household cleaners, swimming pool chemicals, and compressed gas (oxygen and propane) tanks, etc.
Commercial or industrial hazardous waste	Petroleum or other hazardous materials and substances from containers (tanks or drums) or from industrial, commercial, or storage facilities.
Vegetative debris	Downed trees, branches, shrubs and logs, bushes, etc.
Putrescibles	Spoiled or rotten fruits, vegetables, and other agricultural products, as well as meat and dairy products that need refrigeration or freezing to keep them fresh
Affected livestock and poultry	Domestic and farm animal carcasses
Earth materials	Soils and rocks mobilized by earthquake-triggered landslides and deposited on fields, structures, and infrastructure; sand and silt ejected through cracks and deposited on the ground due to liquefaction phenomena; tsunami sludge

). The composition and quantity of earthquake debris depend on the nature of the built environment that will be affected by the strong ground motion and the primary and secondary earthquake environmental effects [5]. Thus, an affected area mainly with wooden buildings will have a different debris composition than one with stone masonry buildings. The 2016 Kumamoto earthquake struck many wooden houses, which were completely or partially destroyed, resulting in a large volume of debris dominated by wood in addition to non-combustible materials, such as broken tiles and concrete rubble from collapsed walls [6].

Differences even exist between earthquake-affected areas with prevailing buildings with load-bearing masonry walls and areas with buildings of reinforced concrete frames and infill masonry walls.

The percentage of concrete in the debris resulting from the 17 August 1999, Mw = 7.6 Izmit earthquake in Turkey and the 12 May 2008, Mw = 7.9 Sichuan earthquake in China was greater than 50%, while it was around 23% in the debris resulting from the 26 December 2004, Mw = 9.2 Indian Ocean earthquake and tsunami in Sri Lanka [6]. Furthermore, masonry constituted about 25%, 40%, and 59% of the disaster waste in Turkey, China, and Sri Lanka, respectively [2,7,8].

Another characteristic example of differences in debris type and quantity between earthquake-affected areas comes from Italy. The 2009 L’Aquila earthquake caused extensive and very heavy structural damage to historic buildings of the densely populated city center, while the 2012 Emilia-Romagna earthquake affected mainly an industrial, sparsely populated area comprising industrial facilities, such as factories, warehouses, and stores [6].

As far as the debris quantity is concerned, the magnitude of the earthquake in combination with the seismic properties of the structures plays a primary role [5]. A moderate earthquake in a city characterized by poor construction criteria may produce a greater volume of debris than a strong earthquake that has struck a city where the buildings have been constructed with strict seismic regulations. The worst-case scenario in which a large volume of debris is generated and difficult to manage is a strong earthquake in areas where seismic regulations are not strictly followed. A typical example of the latter case is the region of East Anatolia, which was devastated by the 6 February 2023 earthquakes that caused severe structural damage to tens of thousands of building structures including their complete or partial collapse and the creation of millions of tons of debris from collapses due to the earthquake and subsequent demolition [9].

The management of the debris resulting from the earthquake disaster is an important step addressed early in the emergency response and recovery stages. The first stage of post-earthquake debris management comprises the emergency clearance of critical areas and infrastructure such as roads, hospitals, and healthcare facilities in order to facilitate access and ensure essential emergency response actions [10]. The removal of earthquake debris is imperative to create safe areas for search and rescue (SAR) teams to settle, operate, and reduce risks shortly after the earthquake. At this stage, it is important to activate crews with the appropriate equipment for debris removal. When the SAR operations are completed and the bodies of the trapped are recovered, the recovery phase begins and the collapse and demolition debris must be removed from the affected areas with the ultimate goal of returning the affected communities to their normalcy as soon as possible. In the second stage of debris management, actions related to sorting and separation of earthquake debris should also take place based on the type and the recyclability of materials to minimize waste and implement sustainable practices. To speed up the whole process, sorting and separation can be carried out at temporary sites or debris management facilities.

However, earthquake debris management poses a major challenge for disaster management staff and residents, as it presents considerable hazards to both the environment and the public health of the affected area [1,3,11,12,13,14].

This narrative review aims to examine hazards that emerge throughout the early phases of debris removal to the last steps of storage, sorting, and disposal of earthquake debris in areas heavily affected by earthquakes and their environmental effects. These hazards are associated with materials that constitute serious threats for all involved in earthquake debris management including not only workers and volunteers but also people who live and work in the earthquake-affected residential areas. These materials encompass asbestos in the form of elongated fibrous crystals, wood treated with toxic preservatives, and decomposing organic waste. Damaged sewage systems may contribute to the presence of fecal-contaminated materials in earthquake debris. Additionally, industrial waste, such as chemicals and heavy metals, as well as household hazardous waste like oils and pesticides, further contributes to the potential hazards that emerge from earthquake debris management.

Furthermore, emphasis will be placed on the environmental threats caused by unregulated debris disposal in natural habitats that are highly sensitive and susceptible to hazardous materials found in debris as part of this recovery activity.

In the same framework, always aiming at disaster risk reduction, measures will be offered to alleviate the negative impacts of debris management on the well-being of all individuals involved, including workers, volunteers, and the local community, as well as the surrounding natural environment, encompassing soil, surface and groundwater, as well as air quality. These adverse effects could create unprecedented conditions during both the emergency and the recovery phases, significantly increasing their duration and burdening not only public health but also the natural environment.

2. Search Strategy

In order to fulfil the purpose of this narrative review, a comprehensive literature search was conducted in all major scientific, technical, and medical research databases of the National Center for Biotechnology Information (NCBI), part of the National Library of Medicine (NLM) to identify environmental and health hazards that could emerge through the management of earthquake debris during emergency response and recovery. This approach enabled us to identify relevant articles, books, and other sources related to the aforementioned environmental and health hazards and gather a wide range of related information. More precisely, searches for certain keywords were performed on ScienceDirect, Scopus, and PubMed. The search criteria were derived from the US Environmental Protection Agency’s (EPA) guidance on natural disaster debris [14] and the World Health Organization (WHO) publication on communicable diseases following natural disasters, risk assessment, and priority interventions [15]. With the particular search terms in the title, abstract, or keywords, all English-language published articles and official reports were screened. An online search utilizing Google and Google Scholar advanced searches was carried out using relevant keyword phrases and associated combinations in order to include articles from official reports and scientific journals not found in the aforementioned databases.

3. Health and Environmental Hazards for Managing Earthquake Debris and Related Impact

Hazards associated with earthquake debris management and its impact on public health and environmental balance will be covered in this section. These public health and environmental hazards will not be separated into different sections as the interactions between the natural environment and humans are numerous. Consequently, hazards that initially affect elements of the natural environment will sooner or later affect public health.

3.1. Hazards from the Generation of Dust

3.1.1. Generation of Dust in Collapse, Demolition, and Debris Disposal Sites

Dust in an earthquake-affected area can be created due to collapse during the earthquake and during the subsequent demolition of buildings (Figure 1a–d). It can be also generated along the debris transportation routes and during debris treatment until their final disposal at selected sites (Figure 1e,f).

The most hazardous material that can be contained in dust is asbestos, a group of fibrous serpentine and amphibole minerals that are non-biodegradable, have extraordinary tensile strength, poor heat conductivity, and are relatively resistant to chemical and thermal effects [16,17]. Because of its properties, asbestos has been widely used worldwide in thousands of applications, including the construction of buildings and infrastructures [16,18]. The most common products of asbestos comprise asbestos-cement building products, asbestos-cement pressure, sewage and drainage pipes, fire-resistant insulation boards, insulation products including spray, jointings and packings, friction materials, textile products, floor tiles and sheets, molded plastics and battery boxes, fillers and reinforcements, and products made thereof [16,17,18].

Regarding the impact of asbestos on public health, asbestos fibers that are 1200 times thinner than hair have the potential to pass through the human body’s natural filtration process, remain permanently in the trachea, lungs, and intestines, and have negative effects on the respiratory system. Asbestos can cause both acute and chronic lung damage by triggering an inflammatory response, with the participation of several cells involved in the production of cytokines, chemokines, oxidants, and growth factors [19]. Because the human body lacks chemical mechanisms for degrading this mineral and is unable to remove fibers that have already penetrated the tissues, there are some adverse effects that, over time, could contribute to the occurrence of several fatal diseases, such as asbestosis, lung cancer, and mesothelioma [17,20,21].

All types of exposure to asbestos fibers can exist for all those who live in earthquake-affected areas or have rushed to support the affected population during the emergency response and recovery, including (i) occupational exposure during job-related activities, (ii) incidental exposure during staying in buildings where the asbestos-containing materials and products have been disturbed, and (iii) the environmental exposure during staying in areas where the ambient air contains asbestos fibers [17]. High-risk groups for asbestos exposure comprise (i) rescued residents near the collapsed buildings in the first hours and days after the earthquake, (ii) members of SAR teams trying to save people from the rubble during the immediate response, (iii) workers and volunteers employed at collapse, demolition, and disposal sites during the immediate response and recovery, and (iv) volunteers called upon to assist in various emergency actions.

After earthquakes and under wind effects, the crushing and erosion of these asbestos-containing construction materials and products produce asbestos fibers and cement mixture being transported and distributed mainly via air and water and contaminating the entire environment to a large extent [16,17]. Airborne mineral fibers may travel significant distances from the source, while asbestiform fibers can be transported over a long range in water [22,23]. Despite the fact that asbestos fibers are relatively stable and are characterized by a high potential to persist under typical environmental conditions [16], they may suffer chemical and dimensional alterations, as well as absorb and carry several organic agents in the environment [24].

Earthquakes around the world that have produced significant dust containing asbestos in the air and caused significant public health impacts are the 17 January 1995, Mw = 6.9 Great Hanshin (Kobe, Japan) earthquake [25,26,27,28], the 6 April 2009, Mw = 6.3 L’Aquila (Italy) earthquake [29], the 20 May 2012, Mw = 6.1 Emilia-Romagna (Italy) earthquake [29], and the 11 March 2011, Mw = 9.0 Tohoku (Japan) earthquake and the subsequent tsunami [30].

After the 1995 Great Hanshin earthquake, Gotoh et al. [28] analyzed air quality through measurements of total suspended particulate matter concentration in the heavily damaged areas comprising urban centers with large buildings and roadways destroyed. This research showed that dust pollution after the earthquake was quite severe because about 3500 abandoned structures were demolished and some of the debris was dispersed as dust particles. Furthermore, during the transport of debris outside the damaged areas, additional dust was released resulting in hundreds of thousands of people being exposed to high dust concentrations [28].

Due to the extensive city destruction and reconstruction following the 1995 Great Hanshin earthquake, the environmental bureau of Kobe city has reported that the earthquake dramatically increased the content of asbestos in the air, which surged more than 20 times the usual one [25]. This abnormally high asbestos level in the air persisted for almost 30 months [25]. Patients from areas affected by the 1995 Great Hanshin earthquake (group 1, G1) reported significantly more cases of upper respiratory tract inflammation as an initial symptom than those from regions unaffected by this seismic event (group 2, G2) [25]. Additionally, during the hospital course, individuals in G1 had a considerably higher rate of severe pulmonary involvement than those in G2. High frequencies of these two presentations may have been brought on by severe air pollution caused by the massive city destruction and reconstruction [25].

Post-disaster dust exposure may contribute to pulmonary alveolar proteinosis (PAP) development. Hisata et al. [26] reported on a 63-year-old Japanese woman who developed PAP as a result of dust exposure following the 1995 Great Hanshin earthquake. The patient repeatedly inhaled dust while visiting a neighborhood that had been devastated by the earthquake without wearing a protective mask. She was diagnosed with PAP 3 weeks after the earthquake when she started to experience a dry cough [26]. In addition, a 41-year-old Japanese man, who inhaled dust while taking part in a building demolition, developed PAP after the 1995 Great Hanshin Earthquake [27].

Recent seismic events that created widespread debris mixed with asbestos are the 6 April 2009, Mw = 6.3 L’Aquila and the 20 May 2012, Mw = 6.1 Emilia-Romagna earthquakes in Italy. About 2400 and 11,000 tonnes of asbestos-contaminated debris have been managed following the 2009 and 2012 earthquakes, respectively [29].

After the 2011 Tōhoku earthquake and the subsequent tsunami, a significant increase in the number of autoimmune pulmonary alveolar proteinosis (aPAP) cases was recorded [30]. These findings add to the mounting evidence that aPAP and dust inhalation are related, although aPAP pathogenesis is not entirely understood.

When earthquake debris disposal sites are developed either close to or within residential areas, then the risk of exposure to asbestos fibers is inherent in many phases of debris management. Typical cases of increased risk of exposure to dust containing asbestos and other hazardous materials and substances during earthquake debris management are reported in East Anatolia by Mavroulis et al. [31] after the devastating 6 February 2023 Turkey–Syria earthquakes. They conducted fieldwork in the affected Turkey provinces in order to identify potential health and environmental risks from managing earthquake debris. As a result, they detected operating disposal sites in four of the most affected provinces in southeastern Turkey with characteristics that prevented them from being categorized as safe for managing earthquake debris. This inadequacy is mainly attributed to their proximity to areas, where thousands of people reside and work (residential building complexes, university campuses, industrial areas, and earthquake camps in cities, towns, and villages) [31].

3.1.2. Generation of Dust during Earthquake-Triggered Landslides and Removal of Accumulated Materials

A typical example of dust cloud formation after landslides is the 17 January 1994, Mw = 6.7 Northridge earthquake in the San Fernando Valley region of the City of Los Angeles (USA). Dust clouds were formed as a result of the mainshock and its strongest aftershocks causing landslides in the Santa Susana Mountains north of Simi Valley [32]. Following landslides, the affected areas presented a sharp rise in coccidioidomycosis cases, which peaked 2 weeks after the earthquake and 203 cases of coccidioidomycosis or valley fever were identified. Fifty-six percentage of them were recorded in the town of Simi Valley. Inhalation of airborne spores of the dimorphic fungus Coccidiodes immitis was identified as the cause of this respiratory disease [33]. Three times as many people as those who did not recall being physically present in dust clouds during the Northridge seismic sequence were more likely to be diagnosed with acute coccidioidomycosis. The risk increased with increasing duration of stay and exposure to dust clouds [34].

3.1.3. Generation of Dust from Removal of Dried Earthquake-Triggered Liquefaction Deposits

Dust with the potential to harm human health can also be generated after earthquake-triggered liquefaction phenomena. When the liquefied material rises to the surface through ground cracks and is exposed to air, it dries out and forms ejecta dust, which can be easily transported by air. Due to the fact that liquefaction-related lateral spreading and ground cracks usually take place and cause damage to the sewage network, diffusion of the contents occurs and can result in contamination of the liquefied material with fecal pathogens and other hazardous materials. Therefore, ejecta dust may be transported by air into or near residential areas and directly lead to increased respiratory tract infections or increased susceptibility to infections, including pneumococcal pneumonia.

A typical example of ejecta dust generation in an earthquake-affected area was observed in Christchurch city in the eastern part of the South Island of New Zealand. The city was struck by an earthquake sequence with a mainshock of Mw = 6.2 on 22 February 2011, resulting in 200 casualties and severe structural damage to 10,000 buildings and infrastructure [35]. In terms of earthquake environmental effects, intense and extensive liquefaction phenomena took place in large areas within and around the city, which were covered by liquefied material including sand and silt (Figure 2a–c). The volume of the material removed from the city by 10 March 2011 amounted to 320,000 tons [36]. During the removal, large dust clouds were generated (Figure 2d–f) characterized by a high potential to adversely affect public health.

This ejecta dust doubled the number of high pollution nights with an average PM10 (particulate matter with a diameter of 10 microns or less) value above the national standards [37]. Based on analysis of the microbiological content of discharge samples collected 5 weeks after the February 2011 earthquake, it was concluded that no fecal pathogens were detected above the normally expected values and that the ejected material represented a low risk of bacterial and viral contamination to the public [38]. However, the sample size was very small [39] and involved only two neighborhoods in Christchurch. Additionally, the study of the spatial/spatiotemporal clustering of pneumococcal pneumonia (PP) before and after the 2011 Christchurch earthquakes revealed that inhaling ejecta dust has increased the absolute number of PP cases [39]. However, it was unlikely to be a direct cause of infection by pathogens found on the surface of inhaled dust particles.

3.1.4. Generation of Dust from Removal of Dried Tsunami Sludge

Tsunami following earthquakes have the potential to cause significant damage in coastal areas and create a large amount of sludge from the bottom of the sea that contains chemical substances, heavy metals, oils, and pathogenic microorganisms. The 2011 Tōhoku tsunami left behind approximately 20 million tons of wrecks, or debris, and 10 million tons of soil sediments, composed of mud and sand, on the ground [40] (Figure 3). The treatment and removal of dried tsunami sludge from the affected areas adversely affected public health.

In Ishinomaki, the most severely affected area by the 2011 Tōhoku earthquake and tsunami, the number of hospitalizations for chronic obstructive pulmonary disease (COPD) exacerbations during the subacute phase (from the third to the fifth week) was significantly higher than before the earthquake (p < 0.05) [41]. The tsunami wrecked several structures in Ishinomaki, and the entire region was buried in a thick layer of mud. Inhalation of dust and fine particles, as well as exposure to chemicals, particulates, and biological elements from debris and tsunami sludge, may have exacerbated respiratory symptoms among COPD patients in the tsunami-affected area [41].

Yamanda et al. [42] reported on two cases of organizing pneumonia (OP) caused by inhaling dried tsunami sludge that formed during the 2011 Great East Japan Earthquake and the consequent tsunami that struck the shores of the Ishinomaki Gulf. Following the disaster, both of these patients had been involved in the restoration work and the removal of dried tsunami sludge. About half a month later, they developed shortness of breath and pulmonary infiltrates and were diagnosed with interstitial pneumonia. Their biopsy specimens were subjected to an electron probe microanalysis, which revealed the presence of earth’s crust elements in the inflammatory lesions [42].

Shortness of breath led to the hospitalization of a man who was manufacturing wood chips from contaminated tsunami debris after the 2011 Tōhoku earthquake and tsunami [43]. His home and workplace both had fungi that could have induced the occurrence of hypersensitivity pneumonitis. His rapid and evolving clinical condition, as well as the results of the bronchoalveolar lavage and surgical lung biopsy, suggested that he may have acute interstitial pneumonia. According to Ohkouchi et al. [43], electron probe X-ray microanalysis showed that large amounts of exogenous materials were deposited in bronchiolar regions, supporting the theory that inhaling harmful substances from the dried tsunami sludge was the causative agent of acute lung injury [43].

3.2. Hazards from Treated Wood and Wood Preservatives

In order to protect the wood from various degradation factors, such as fungi, pests, and wood-eating insects, it must be treated with various methods usually involving the application of water- or oil-based preservatives that contain mixtures of ingredients, some of which are hazardous. The water-borne wood preservative that is most frequently used is chromated copper arsenate (CCA), which has excellent fungicidal and insecticidal properties and a high potential to extend the useful life of treated wood by 45 years or more [44]. During the pressure treatment process, CCA is applied to the wood resulting in large copper (Cu), chromium (Cr), and arsenic (As) concentrations.

Another effective water-borne wood preservative is the ammoniacal copper zinc arsenate (ACZA) [45]. These preservatives are commonly used in buildings and infrastructures comprising walkways, piers, restraining walls, and bridges. Other wood preservatives include ammoniacal copper quaternary type B (ACQ-B), amine copper quaternary (ACQ-D), ammoniacal copper citrate (CC), and copper dimethyldithiocarbamate (CDDC) [45].

Due to the massive amount of treated wood in areas devastated by an earthquake, the dispersal of these preservatives could create health hazards for all involved in debris management, including workers, volunteers, as well as affected residents. During processing, risks to humans and the environment arise from (i) As, Cu, and Cr leaching at large concentrations [45,46,47]; (ii) mixing with untreated wood when recycling; and (iii) incineration when the resulting As emissions necessitate the utilization of suitable air pollution control apparatus and when the concentration of As, Cu, and Cr in the ash limits its management options [48,49,50,51].

In addition, the release of these metals has been reported by many researchers during the life of wood [52,53], during disposal [54,55,56], and from recyclable products [53,57]. Decay can increase As leaching rates on a percentage basis; however, because the retention of metals in wood decreases over time, the mass of metals leached will decrease. Despite the reduction in total leached mass, metal leaching from wood continues over the life of the wood, and the leaching mechanism changes as the wood erodes due to loss of Cr fixation, wood cracking, and fiber deterioration [58].

In some countries, using landfills to dispose of treated wood has been ruled out and after all reuse options have been exhausted, the material is incinerated [59], while in others CCA-treated wood is usually disposed of in landfills without any prior treatment. A natural concern when disposing of damaged treated wood in landfills is the potential for the release of preservative chemicals at levels that harm the environment or make it difficult for the landfill operator to collect and manage site runoff [54].

Wood products treated with CCA were found to have an adverse impact on the environment and human health due to the leaching and accumulation of As, Cr, and Cu, especially As. They leach into soils and waters with a negative impact on food production, farming, and animal and human health due to their toxicity and carcinogenicity and their potential as oxidative stress agents to human, aquatic, and soil-based organisms [60].

Workers, volunteers, and locals involved in earthquake debris management can be exposed to the harmful properties of these metals. Exposure to CCA-treated wood promotes As accumulation via inhalation [61]. Other residents in an earthquake-affected area can be exposed to these elements, especially children in parks and playgrounds where they can more easily come into contact with CCA-treated wood products [62].

As has been shown by relevant research and reports by the World Health Organization and other health institutes, exposure to As can cause damage to certain components of the central and peripheral nervous system and hearing ability [63,64]. Poisoning with As was also associated with immune system suppression and increased fetal mortality in rats [65].

According to the EPA Carcinogen Group [66], inorganic As has been classified as a carcinogen belonging to Group A. Exposure to As through inhalation, ingestion, and dermal contact can increase the incidence of cancer in the urinary bladder, kidney, liver, lung, and skin [67,68,69,70]. In addition, As has been reported to cause a large amount of oxidant species in exposed animals creating oxidative stress and causing severe imbalance in redox systems [61]. Poisoning with As results in the development of certain clinical features such as anemia, weakness, abdominal pain, gastrointestinal problems, diarrhea, vomiting, skin diseases, hypertension, encephalopathy, behavioral changes, and malignancies in almost all organs of the body [71].

Trivalent Cr compounds have two to three times less toxicity than hexavalent Cr that is present in CCA and has carcinogenic potential in humans [72,73]. Human exposure to hexavalent Cr occurs through inhalation, ingestion, and absorption through dermal contact [74]. Long-term exposure to hexavalent Cr causes skin irritation and rashes and respiratory tract airway erosion and irritation that damages mucous membranes and increases the risk of lung cancer [75,76]. Cr has also been found to exhibit nephrotoxicity and hepatotoxicity and has teratogenic effects in exposed animals [77,78].

Cu is toxic to fish and various other marine vertebrates. High concentrations cause toxic effects on both humans and other mammals [75]. Abnormalities in Cu metabolism due to mutations in genes related to Cu metabolism can cause Wilson’s disease, which is reported to lead to liver failure or severe neurological failure and loss of life without early recognition [79,80].

If debris, including CCA-treated wood, is burned, Cr, Cu, and As will disperse into the air, exposing human lungs to these heavy metals. Inhaling inorganic As and being exposed to hexavalent Cr have been shown to raise the risk of lung cancer in humans, but there is no information on the carcinogenicity by sole exposure to Cu [81,82,83,84]. Ohgami et al. [84] demonstrated the increased carcinogenic risk by co-exposure to Cr and As in the process of incineration of debris including CCA-treated wood following the disaster and suggested the importance of avoiding diffusion of these heavy metals in the air via debris incineration.

One of the most typical examples of disasters that produced debris composed of a large amount of treated wood is the 2011 Tōhoku earthquake and its subsequent tsunami. A total of 20 million tons of debris, primarily from the demolished wooden houses, were produced by the aforementioned disaster on 11 March 2011 that may have high amounts of Cr, Cu, and As due to the previously used CCA-treated wood. Both recycling and burning were used for debris disposal.

3.3. Hazards from Heavy Metals and Other Chemicals

Earthquake debris may have a substantial influence on both surface and groundwater. They may introduce pollutants including heavy metals and other chemicals into nearby bodies of water, such as streams, lakes, rivers, and the sea, with long-term adverse effects on surface water ecosystems. Contaminated water bodies reduce the quality of water, making it harmful to aquatic life and dangerous for irrigation and supplies.

The case of demolition debris from the town of Boumerdes in northern Algeria, five years after the 21 May 2003, Mw = 6.8 earthquake, is a typical example of the effects of earthquake debris on groundwater [85,86]. Benmeni and Benrachedi [87] found that the concentrations of heavy metals (cadmium, chlorine, zinc, and nickel) in samples of the leachate of the landfills and control wells were above acceptable limits, causing two types of pollution: (i) an organic one leading to high chemical oxygen demand (COD) and (ii) a mineral one leading to high concentrations of additional heavy metals in the drainage. Furthermore, the considerable prevalence of coliforms and fecal streptococci can only be explained as a result of contamination caused by drainage penetration through cracks in the porous soil [87].

3.4. Hazards from Putrescibles

When the earthquake causes extensive damage to elements of the electricity network, there are extensive interruptions in electricity supply to homes and businesses that can compromise the safety of food supplies. The risk is higher in commercial properties including supermarkets, food warehouses, cool stores, and hospitality businesses, where large quantities of perishable products are stored. If proper storage and refrigeration are disrupted, perishable food can spoil quickly, providing an ideal environment for the growth of bacteria, such as Escherichia coli, Salmonella spp., and Campylobacter spp. These bacteria have the potential to cause foodborne diseases, which manifest as nausea, diarrhea, vomiting, and abdominal pain when consumed.

Food may also be exposed to moisture and insufficient ventilation, both of which promote mold growth. Consuming food contaminated with mold or mold-derived compounds (mycotoxins) can cause respiratory issues and, occasionally, mycotoxicosis. In particular, mycotoxicosis can cause both acute and chronic negative health effects in humans via inhalation, ingestion, skin contact, and entry of mycotoxins into the bloodstream and lymphatic system [88].

3.5. Hazards from Fecal-Contaminated Materials in Debris

When the earthquake causes damage to the sewage network either due to the rupture of wastewater pipes or due to the destruction of treatment facilities, then the waste may contaminate surrounding geological deposits, the surface water bodies, and the groundwater systems. This contamination with fecal matter and pathogens has the potential to transmit waterborne diseases, such as cholera, typhoid fever, and hepatitis A, to workers, volunteers, and residents involved in debris removal and damage repair without using the appropriate personal protective equipment. This hazard prevails in areas affected by extensive liquefaction phenomena. The resulting cracks can affect parts of the sewer network, such as wastewater pipes and cesspits, and lead to extensive soil and water contamination with subsequent impact on public health [89].

3.6. Hazards from Injuries and Wounds from Earthquake Debris

Another threat to the health of those either living close to or working in the collapse, demolition, and earthquake debris disposal sites during the immediate response and recovery phase is tetanus, an infectious disease brought on by spores of Clostridium tetani coming into contact with open, exposed wounds. This disease is fatal but can be prevented through vaccination. During the evacuation, the debris removal, and subsequent demolitions, there is an increased risk of injuries, such as cuts, punctures, and abrasions to the skin, during the evacuation, the removal of debris, and the subsequent demolitions. Debris management workers, volunteers, and residents are in direct contact with hazardous materials of various origins, e.g., building and infrastructure construction materials, which may contain or be mixed with hydraulic materials, human or animal faces, and rusty objects. Any break in the skin allows C. tetani to penetrate the human body and cause tetanus.

In the context of research on the impact of earthquakes on public health and particularly on infectious diseases in the post-disaster period conducted by Mavrouli et al. [89], tetanus outbreaks have been documented in Indonesia after the 2004 earthquake, in Kashmir after the 2005 earthquake, in Yogyakarta after the 2006 earthquake, and in Haiti after the 2010 earthquake [90,91,92,93]. Among tsunami survivors in Acheh and Yogyakarta provinces, 106 and 71 cases of tetanus were recorded, respectively. Most patients sustained injuries during either evacuation or post-disaster resettlement [94]. Another epidemic with 139 tetanus cases occurred in the 2005 Kashmir earthquake [91,94]. In Pakistan, 22 of the 51 multi-injured patients who needed respiratory support due to tetanus infection passed away [90]. In all cases, low vaccination coverage of the population, poor access to health care, and ineffective treatment contributed negatively to case severity and response time. Additionally, 26 tetanus cases, including 8 human fatalities, were recorded after the 2006 Yogyakarta earthquake. Important factors contributing to the human casualties were the distance of the patient from the hospital and the type of health facilities [92].

3.7. Hazards from Debris Associated to Disrupted Sanitation and Waste Management Systems

Earthquake debris combined with disrupted sanitation and waste management systems can either create favorable breeding grounds for arthropods such as mosquitoes, flies, and mites or result in an increased presence of reservoir hosts such as rodents that contribute to the transmission of various infectious diseases. In particular, stagnant water accumulated in debris, damaged sewage systems, and unsanitary conditions can contribute to disease-carrying vector proliferation and raise the possibility of arthropod-borne diseases emergence. Flies can transfer enteropathogenic bacteria like E. coli, Campylobacter spp., Shigella spp., or Salmonella spp. from contaminated debris to fresh food, increasing the risk of foodborne infections [95,96]. Mosquitoes may transmit mosquito-borne diseases including West Nile fever, dengue fever, Zika virus disease, and malaria, while rodents can carry and spread spirochetes of the genus Leptospira that cause leptospirosis.

The transmission of leishmaniasis is influenced by the presence and behavior of phlebotomine sandflies, the reservoir hosts, and the prevalence of the Leishmania parasites in affected regions. Epidemics of cutaneous leishmaniasis have occurred following the 26 December 2003, Mw = 6.6 Bam (Iran) earthquake, with the number of recorded cases nearly quadrupling two years later [97]. Risk factors that have increased the disease incidence include village expansion, development of formerly uninhabited regions, construction of new settlements, and improper management of debris and waste piles [98]. The production of 10 million tons of debris following the 2003 Bam earthquake created ideal conditions for the sandflies proliferation, the primary Leishmania species vector, while the post-earthquake behavior of residents and recovery workers removing debris, restoring houses, and living under substandard living conditions increased their exposure to sandfly bites [99].

In Nepal, outbreaks of scrub typhus were reported in earthquake-affected areas a few months after the 25 April 2015, Mw = 7.8 Gorkha earthquake and the subsequent strong aftershocks [100,101]. The collapse of buildings resulted in a greater number of rodents circulating and carrying mites infected with Orientia tsutsugamushi, which in turn raised the risk of human exposure to these arthropod vectors and the emergence and development of relevant infectious diseases [89].

3.8. Hazards from Dumping Debris Either Close to or within Natural Habitats

The disposal of earthquake debris may have a substantial impact on natural habitats. Improper disposal methods, including throwing debris into or near water bodies, can change the way water flows naturally, lead to sediment built-up, and harm aquatic life by limiting sunlight and oxygen availability. Furthermore, the disposal of debris into natural habitats may impair their natural ecological processes. Habitat destruction can restrict wildlife migration patterns, disturb breeding regions, inhibit the recycling of nutrients, and disrupt food and shelter availability. These changes can cause a domino impact on biodiversity, population dynamics, and resilience of natural habitats throughout the ecosystem.

Another hazard that can emerge and affect natural habitats by debris disposal is the introduction of invasive or non-native species into habitats. The debris may contain seeds from soil or other materials that carry non-native species that may spread and dominate at the expense of existing species, limiting biodiversity, leading to a disruption of the ecological balance and to negative impacts on native flora and fauna.

The dumping of debris in natural habitats can lead to their segmentation and create isolated patches resulting in a reduction in the ability of species to adapt to changing conditions and increase their vulnerability.

A typical and very recent example of an uncontrolled disposal of earthquake debris in a natural habitat comes from East Anatolia and in particular the Samandağ coastal area of Hatay province, which was profoundly impacted by the devastating earthquakes that occurred in early February 2023. This site was created in a coastal zone with geological, geomorphological, and historical features that make it particularly vulnerable to human intervention and activity [31]. It was created within a coastal marsh, very close to the outlet of a stream (Figure 4) and in close proximity to residential areas, such as the town of Samandağ and its suburbs, and adjacent to emergency shelters (Figure 4), with all that this implies for public health safety [31].

3.9. Hazards from Noise Related to Debris Management Activities

Increased traffic during debris transport as well as utilization of heavy machinery and equipment in demolition and transportation can all contribute to noise pollution from debris management following earthquakes.

The transportation, processing, and disposal of earthquake debris, as well as the construction and preparation of debris disposal sites, often require the use of heavy machinery and associated equipment that generate significant noise from the continuous operation of engines, audible alarms, warning systems, and the constant movement of machinery, as well as from the demolition of structures, the breaking of concrete, and the compaction of debris. This increased noise can cause disturbance to the tranquility of a residential region or the equilibrium in sensitive natural habitats.

3.10. Hazards from Disturbance of Aesthetics

Visual pollution is related to the selection of unsuitable locations for debris disposal close to residential areas, areas of scenic ecological value, and sensitive natural landscapes, as well as the application of inappropriate treatment and disposal methods, which can significantly affect the aesthetics and tranquility of the environment. When residents are confronted with images of scattered random debris or inadequate mitigation measures to limit the adverse impacts of debris disposal, it can create a sense of neglect by the relevant disaster management agencies and a sense of environmental degradation in the area in which they live and work with possible subsequent negative impacts on various aspects of human life.

4. Measures to Address Debris Management Risks on Public Health and the Natural Environment

Measures to reduce or eliminate the risks of earthquake debris management on public health and the environment can be divided into (i) protective measures for all involved in debris management against hazardous materials, (ii) preparation and implementation of an earthquake debris management plan, (iii) activities for the dissemination of information to the affected population, and (iv) systematic instrumental monitoring of environmental parameters.

4.1. Protective Measures for All Involved in Debris Management

4.1.1. Protection Measures against Exposure to Dust Containing Asbestos

As for the workers involved in debris management from the first phase of loading at the collapse and demolition sites to the final disposal phase, they should be fully informed about the hazards they will face when handling debris and the best practices they are required to apply when involved in the clean-up process. If they are not adequately informed, training and awareness-raising activities should be carried out either by the relevant government authorities involved in disaster management and recovery or by the appropriately trained staff of the contractors involved in debris management.

Workers, volunteers, and residents should use appropriate personal protective equipment (PPE) at all times during their involvement in debris management [3], at the sites of collapses and demolitions, during transport, and at the final disposal site. The PPE should primarily and above all comprise protection masks not only against dust and large grain contaminants but also against hazardous materials, including asbestos fibers as well as hazardous vapors and liquids. The PPE should also include disposable mechanical, chemical, and microorganisms-resistant work gloves in order to prevent toxic or irritating substances from coming into contact with the skin; fully enclosed goggles (better for ash) or safety glasses whenever there is a risk of physical, biological, or chemical eye injury; and disposable or replacement clothes so that those involved do not take contaminated clothing back home and place other people at risk. The PPE users must be trained and authorized to use it and must inspect it prior to each use. Contaminated PPE and clothing should be disposed of in the same manner as other construction materials from demolition and collapses containing asbestos.

Similar PPE should be used by people living and working close to the above sites, for example, in camps for the accommodation of earthquake-affected people. If this equipment is not available and dust generation continues to make a big difference in the surrounding area despite the implementation of risk reduction measures, then residents should be evacuated until the debris management process is completed. Similar protective measures should be taken by residents and volunteers, who participate in the above actions as they all face the same risk of exposure to the hazardous materials.

In order to prevent residents from being exposed to hazardous materials during the processing and transport of debris, additional measures should be taken to limit the generation of dust. During the loading of debris in the demolition and collapse sites, the loading area should be sprayed with water in order to ensure the precipitation of dust and free asbestos fibers. When transporting debris by heavy trucks, the loaded debris should be covered with material that prevents dust from escaping into the environment. The roads leading to the disposal site and those used by the trucks for debris transport should be watered at regular intervals per day and remain wet all day in order to prevent dust generation during the passage of vehicles and heavy machinery.

Additionally, workers should be provided with washing facilities before leaving the collapse, demolition, and debris disposal sites and returning home. This measure further reduces the risk of spreading asbestos fibers outside the aforementioned sites.

To limit the release of asbestos fibers into the air at collapse and demolition sites, properly trained staff should be available and ready to identify the type of asbestos-containing materials, the risk they pose, and the correct and effective way to manage them, which may include prohibiting their movement, secure sealing, and remaining in place with appropriate information signage. These hazardous materials should be removed by qualified and trained staff who apply acceptable and safe procedures and use appropriate PPE until the processes are completed.

For the proper management of debris and asbestos-containing materials, specific procedures must be implemented to avoid the dispersion of asbestos fibers in the environment. These are the following according to WHO [102]:

• Materials containing asbestos should be transported without breaking and should not be mixed with other debris before final disposal. If it becomes necessary to move or disperse these materials, they should be kept well dampened to limit the amount of fibers that can become airborne.
• Materials containing asbestos should be disposed of in areas appropriately selected and designed to prevent the release of asbestos fibers into the environment. Such sites must be equipped with a drainage collection system and a system for the immediate covering of newly deposited waste with a layer of suitable inert material. In addition, future construction work such as gas extraction wells or drainage wells should not be carried out on the sites where asbestos-containing materials are disposed of in order to avoid re-exposure to asbestos. All these sites should be recorded in databases in great detail and analysis. This information should be available at all times to prevent any future construction and intervention from disturbing them.
• On arrival of trucks at the disposal sites and before unloading, any surface exposed to asbestos should be sprayed with water. The storage or disposal of asbestos-containing materials shall be in sealable containers. These containers shall be made of metal, plastic, or polyethylene. If the containers are crates, barrels, or sacks, they should be securely sealed and specially marked with information messages about the harmful contents and the risks involved.

4.1.2. Protection Measures against Exposure to Treated Wood

To avoid impacts from treated wood on humans and the environment, the first priority is to keep treated wood out of the debris, which can be achieved by collecting and reusing it if it still meets the requirements of its original design [57,103]. If it does not meet the requirements for reuse and must be discarded, appropriate treatment as per international practices should be followed. Further treatment should include storage in a permitted bulky waste landfill or burning in a burner facility properly equipped with the appropriate specifications for burning treated wood. These residues should never be burned in open outdoor areas as burning releases chemicals in ash and smoke [14]. If this wood is in the form of sawdust, chips, and other small residues, composting should not be the preferred approach [57,103,104], but rather the above treatment should be used. In all cases, the regulations and restrictions provided in any local or regional plan for earthquake debris management and for the management of hazardous materials including treated wood should be applied [57,103].

Landfills for bulky waste should not be developed near water bodies, such as streams, rivers, and lakes, as well as drinking water sources such as wells, water reservoirs, and covers [57].

To avoid impact on animals and subsequently on humans, treated wood residues should be disposed of in areas away from animal feed and food-producing animals as the chemicals released from treated wood can pass into various products, such as meat, milk, and eggs, among others [57].

To protect against contact with the above hazardous materials, PPE including durable gloves and long-sleeved clothing, dust mask, as well as protective goggles and glasses should be used when working with such wood, for example, sawing, sanding, shaping, or any other treatment [57,104].

After exposure to these hazardous materials, hands and any other exposed part of the skin should be washed thoroughly before any other activity, especially before eating, drinking, and smoking. In addition, clothing after treatment should either be disposed of or washed thoroughly, especially separately from other clothing.

4.1.3. Prevention and Control Measures for Tetanus

Although tetanus can be prevented with a highly efficient vaccine, it remains a leading cause of morbidity and mortality globally, especially in earthquake-affected areas during the recovery period. The mortality rate remains high in countries where the coverage of tetanus vaccination is low to non-existent. In cases of trauma exposure to microbial spores, the factors that shape successful tetanus treatment are early diagnosis, early administration of muscle relaxants and sedative therapy, keeping the airways open and the potential use of a mechanical ventilator to assist in respiratory failure management [89].

Vaccination awareness, recommendations, and coverage for workers, volunteers, and affected residents exposed to hazardous elements of the earthquake debris should also be developed and implemented always in cooperation and consultation with the local and regional healthcare authorities [105]. More specifically, the tetanus vaccinations should be up to date. Furthermore, vaccination should also be carried out for other infectious diseases that may frequently develop in earthquake-affected areas and in particular in areas with very severe structural damage, including collapses and subsequent demolitions. Implementations of vaccination strategies and raising awareness activities should be included in a regular surveillance system in addition to disaster management and related support programs for affected earthquake victims. A disease surveillance system establishment significantly contributes to disease trends monitoring, prompt detection and reporting of cases, and immediate implementation of therapeutic and preventive interventions against disease occurrence during emergency response and recovery phases [89].

4.2. Preparation and Implementation of Earthquake Debris Management Plans

For the proper and effective management of debris from an earthquake, the agencies involved in disaster management, in cooperation with communities and scientific institutions, should develop an earthquake debris management plan. This plan should include and cover the following issues: composition and quantity of the generated debris; their collection, handling, treatment, and disposal; and the management of the associated hazards, as well as the strategic and operational management, the funding for management of earthquake debris, and the associated regulations [3,106,107]. These management plans should be guided by the principles of sustainable disaster debris management and adopt the results of research related to the circular economy, the reduction of debris to a minimum, the extension of the life cycle of materials, and the creation of further value [108,109,110].

With regard to the debris composition and quantity, the main categories of buildings in each residential area should be assessed and the units, the volume, and the area of debris should be estimated. The results should be taken into account in the subsequent debris management phases.

With regard to debris collection, the transport routes for prioritizing debris removal, the facilities and equipment for debris removal, and the debris collection strategy for the recovery stage should be identified [106].

The procedure is not the same for all cases, even for earthquake events that have occurred in the same country with the same general institutional framework for the management of debris from disasters induced by natural hazards. For example, in Italy after the 2009 L’Aquila earthquake, the debris was first pretreated on-site before being transported to an old quarry for storage, final treatment, and disposal [29]. Following the Emilia-Romagna earthquake in 2012, all the debris were taken straight to facilities for recovery and disposal [29].

Information on vehicles, facilities, and equipment for demolition and removal of debris from the collapse and demolition sites should be included. Issues related to the provision of fuel for vehicle facilities and food and water for those involved in debris collection should be resolved. Approaches to debris transportation and temporary storage and disposal strategies should be adopted. The roles of the public agencies involved should be clearly defined. With regard to temporary debris sites, the general locations for the establishment of the sites should be checked for suitability and classified according to the size and activities they could accommodate [106].

For assessing the suitability of the sites, an initial environmental analysis and assessment of the environmental and seismic risks should be performed on these sites. Appropriate types of debris and suitable activities for these sites should be identified, such as the sorting and recycling of demolition and collapse debris and the treatment of hazardous materials and their disposal. Contractors, staff needs, and related facilities should also be specified.

With regard to the management of associated risks, the numerous environmental and public health hazards and risks must be assessed and the impact of their potential occurrence must be mitigated during management.

As far as the related funding is concerned, the private and public funding sources for the different stages of management shall be determined before the occurrence of the destructive events.

All of the above must be governed by regulations that ensure proper environmental management and public health safety, post-disaster management of buildings, and waste management in general.

In terms of debris recycling and disposal, debris management facilities including construction and demolition landfills, cleanfills, recycling facilities, processing plants, and composting facilities, as well as hazardous materials treatment facilities should be initially defined along with the service providers comprising collection contractors for demolition and transport companies [106]. The assessment of existing capacity and cost–benefit analysis of recycling and disposal options should follow with the assessment of the availability of temporary and permanent sites, personnel, and facilities for debris management. The final stage of recycling and disposal analysis comprises the identification of markets for debris materials and their use during recovery and reconstruction in order to extend the life cycle of the materials and reduce waste to a minimum.

In order to identify and select suitable disposal sites, the primary and secondary criteria for their selection must be strictly defined and the potential problems and environmental impacts of the sites must be identified [106]. The primary criteria are related to (i) the ownership of the site, (ii) its proximity or location within areas that are susceptible to the occurrence of geophysical or hydro-meteorological hazards, for example, within floodplains, within or close to landslide zones, in areas that may adversely affect surface water bodies or groundwater systems, and (iii) their distance from areas of high natural and cultural value. Secondary criteria have to do with the characteristics and properties of the disposal site that contribute to increasing public health and environmental impacts, such as slope, lithologies of geological formations and deposits, and geotechnical characteristics of the site.

As part of hazard identification and management, potentially hazardous materials that may be found in the debris should be identified pre-seismically to determine the precautionary procedures required during demolition, transport, treatment, and disposal and to identify related facilities. For example, in the context of debris management from the 2016 Kumamoto earthquake, policies were established to reduce the risk of fire in temporary storage areas, e.g., the height of piles of combustible mixed waste should not exceed 5 m (only combustible waste such as damaged wooden materials: less than 2 m), the area per waste pile should be less than 200 m², and the distance between piles should be greater than 2 m [6].

Another practice that should be incorporated into debris management plans is the use of local resources, means, and staff in many of the clean-up activities in the affected area [14]. This guides more resources into the local community and enhances the emotional recovery of survivors who are actively involved in the recovery and reconstruction of the area in which they have lived for many years.

Another important element for effective earthquake debris management is the cooperation between communities and organizations within and outside the earthquake-affected area [6]. A typical example is the management of debris from the 2011 Tōhoku (Japan) earthquake and subsequent tsunami. After the sequence of the disastrous events, despite the request of governmental authorities to communities outside the devastated areas to contribute to the collection and removal of disaster debris, it was difficult for local governments and residents outside the earthquake-affected area to accept mainly for public health reasons as the disaster debris contained various hazardous materials. After financial support from the central government and solidarity with the earthquake and tsunami victims, the neighboring municipalities accepted to participate in disaster waste management [6].

Something similar happened again in Japan after the 2016 Kumamoto earthquake [6]. The Waste Management Association of Japan solicited the support of municipalities across the country and coordinated assistance and treatment of the earthquake debris [6]. Several municipalities helped the earthquake-affected city based on previous mutual aid agreements. They sent garbage trucks and staff to the affected areas to collect household waste and other debris, and staff experienced in disposing of disaster debris generated by the 2011 Great East Japan earthquake assisted in the compilation of disaster debris management plans for the earthquake-affected Kumamoto area. In addition to equipment and staff, this support included transportation and treatment of debris in facilities located outside the earthquake-affected area. Furthermore, the governmental authorities coordinated a network of groups comprising different research institutions, waste management associations, and federations in order to provide support to local or municipal governments along with emergency response groups and recovery/restoration groups [6]. The main issues that needed to be addressed included securing and managing temporary storage sites, supporting on-site and providing guidelines about treating debris difficult to dispose of, and providing support for the management of residential waste from the first phase of the collection until the final disposal.

However, there are also cases where there is a lack of technical and operational knowledge and financial capacity to manage debris in affected communities. The communities in Nepal after the 25 April 2015, Mw = 7.8 Gorkha earthquake constitute a typical example of this issue. The lack of such knowledge and capacity by the majority of earthquake-affected communities resulted in residents removing debris on their own [4], exposing them to serious associated hazards. Despite the lack of proper management of debris and waste due to the absence of policies and guidelines on debris, residents reused a large percentage (57.96%) of the generated debris in buildings’ reconstruction [111]. In such cases, national authorities should provide direct support to local experts and should give clear guidelines to local and regional authorities on how to manage earthquake debris most effectively [4,14,111].

The ideal scenario for rapid recovery in an earthquake-affected area is that debris removal, processing, and disposal should be performed quickly, but with all necessary measures in place to avoid adverse effects on the natural environment and public health. However, even if there are delays, for example, in the selection of temporary and permanent disposal sites, these can be beneficial at least to the correct and efficient debris management. A typical example of delays in debris management was the case of L’Aquila, which was affected by the 2009 earthquake [112]. The delays in debris removal from the city center and in the selection of temporary and permanent disposal sites due to complex legal requirements for waste management may have caused temporary dissatisfaction among the local population, as the earthquake debris acted as a reminder of the losses they have suffered. However, the delays allowed more thorough environmental studies to be carried out to ensure the correct selection of debris disposal sites, thus minimizing the future potential for adverse impacts on both the natural environment and public health from rapid and indiscriminate debris dumping at random locations [112].

Delays can also occur at various stages of debris management, such as in recycling, which, although slowing down the whole process, contributes positively to maintaining the natural environment balance and public health safety in the long term. These cases highlight not only the great importance of education and awareness-raising actions for the affected residents by the competent disaster management authorities but also the importance of having a debris management plan already before the earthquake, which includes sites that meet all the requirements and criteria to function as debris disposal sites.

4.3. Dissemination of Related Information to the Affected Population

One of the most important actions for effective debris management is the coordination and dissemination of information to the public in terms of effective debris disposal from residential and commercial properties [106]. It is very important for residents to promptly understand the right actions to take in disposing of earthquake debris and waste from their daily activities. For this reason, a communication and information strategy should be developed to inform communities so that they know in advance the actions they need to take before the earthquake. The compilation of communication and information dissemination plans should involve the emergency services, government agencies at all levels (local, regional, and national), debris management teams, debris collection and disposal contractors, local authorities, and communities, with the final beneficiaries being the citizens of the earthquake-affected areas.

4.4. Systematic Instrumental Monitoring of Environmental Parameters

A very important measure to address the risk from hazardous materials and substances at the sites of removal and disposal of debris is the systematic instrumental monitoring of environmental parameters within the sites and in the surrounding areas [8,14]. In the case of the 2016 Kumamoto earthquake, monitoring included visual inspection for contamination control and soil analyses, according to the results of which countermeasures against soil contamination were taken as needed [8].

The results of these measurements must be taken into account by the authorities concerned, which will take the necessary measures to protect both the natural environment and public health. It is very important that these results are freely available to the general public.

There should be a continuous identification of the parameters to be monitored, the protocols to be used, and the frequency and requirements of the presentation of results to the public. More reliability and consistency could be achieved if monitoring was carried out by official governmental authorities in collaboration with and support from academic institutions, research bodies, and debris management companies [14].

4.5. Summary of the Proposed Measures for Risk Reduction during Earthquake Debris Management

The above measures are summarized in

Table 2. Adverse phenomena related to earthquake debris management and related impact on the environment and public health.

Adverse Phenomena	Impact on Public Health and Environment	Measures for Debris-Related Hazard Mitigation
Generation of dust containing asbestos during various phases of earthquake debris management	Negative effects on the respiratory system	Training and awareness-raising activities by government authorities or appropriately trained staff of contractors in debris management. Removal of asbestos-containing materials following safe procedures. Appropriate PPE for workers and volunteers during management and for people living close to disposal sites. Spaying of the loading area with water to ensure dust precipitation. When transported by trucks, the routes should be watered on a regular basis. Use of washing facilities before leaving collapse, demolition, and disposal sites.
	Acute and chronic lung damage
	Occurrence of several fatal diseases, such as asbestosis, lung cancer, and mesothelioma
	Pulmonary alveolar proteinosis (PAP) development
	Upper respiratory tract inflammation
Fecal-contaminated materials in debris	Cholera	Disease surveillance systems for rapid detection and effective treatment of sporadic cases, outbreaks, and epidemics of infectious diseases.
	Typhoid fever
	Hepatitis A
Injuries and wounds during earthquake debris management	Tetanus	Implementation of vaccination strategies and awareness activities. Effective vaccination and coverage of workers, volunteers, and residents. Early diagnosis, early administration of muscle relaxants and sedative therapy.
Earthquake debris combined with disrupted sanitation and waste management systems creates favorable breeding grounds for mosquitoes, flies, and mites and the increased presence of reservoir hosts such as rodents	Foodborne infections	Disease surveillance systems for rapid detection and effective treatment of sporadic cases, outbreaks, and epidemics of infectious diseases.
	Mosquito-borne diseases including West Nile fever, dengue fever, Zika virus disease, and malaria
	Rodent-borne diseases (leptospirosis)
	Leishmaniasis
	Scrub typhus
Generation of dust due to removal of earth materials (landslide material, ejecta dust, tsunami sludge)	Coccidioidomycosis	Appropriate PPE for people being close to earthquake-affected areas with dust generated by the removal of earth materials. Disease surveillance systems for rapid detection and effective treatment of infectious diseases.
Spoiled food forming breeding ground for bacteria	Foodborne diseases, presenting with symptoms like diarrhea, abdominal pain, nausea, and vomiting	After exposure to hazardous materials, hands and any other part of the skin should be washed thoroughly, especially before eating, drinking, and smoking.
Food left exposed to moisture and inadequate ventilation leading to mold growth on food items	Allergic reactions, respiratory issues, and, in some cases, mycotoxicosis
Disposal of treated wood in landfills without prior treatment	Exposure to As: damage to components of central and peripheral nervous system, hearing ability, cancer incidence increase in lungs, liver, kidneys, urinary bladder, and skin	Separation of treated wood from debris. Storage of treated wood in a permitted bulky waste landfill.
Burning of CCA-treated wood	Poisoning with As: development of certain clinical features such as anemia, weakness, vomiting, abdominal pain, diarrhea, gastrointestinal problems, skin diseases, hypertension, behavioral changes, encephalopathy, and malignancies in almost all body organs	Burning of treated wood in a burner facility properly equipped with appropriate specifications.
Leaching of chemicals and heavy metals from the wood during disposal and from recyclable products	Chronic exposure to hexavalent Cr: skin irritation and rashes, respiratory tract airways erosion, and irritation causing damage to mucous membranes and lung cancer development	Storage of treated wood in a permitted bulky waste landfill away from water bodies and ground water systems.
	Co-exposure to Cr and As: increased carcinogenic risk
Bringing heavy metals and other chemicals into surrounding water bodies	Degradation of water quality and water toxic for aquatic life and hazardous for irrigation and supplies
Dumping debris into or near water bodies	Alteration of natural water flow patterns, sediment accumulation, negative effect on aquatic species by reducing available oxygen and obstructing sunlight	Selection of suitable disposal sites away from water bodies and ground water systems, residential areas, and areas of high natural and cultural value. Systematic instrumental monitoring of environmental parameters in the selected debris disposal sites and in the surrounding sensitive natural habitats. Results freely available to the general public and application of countermeasures against the adverse effects when and where necessary.
	Impairing natural ecological processes
	Restrictions of wildlife migration patterns, disturbance of breeding regions, prevention of nutrient recycling, changes in the availability of food and shelter
Increased traffic during debris transport and utilization of heavy machinery and equipment during demolition and transportation	Noise pollution comprising disturbance to the tranquility of a residential area or the equilibrium in a sensitive natural habitat
Selection of unsuitable locations for debris disposal close to residential areas, areas of scenic ecological value, and sensitive natural landscapes and application of inappropriate treatment and disposal methods	Visual pollution comprising creation of a sense of neglect by the relevant disaster management agencies and environmental degradation in the areas where the affected people live and work

along with the adverse phenomena during different phases of the earthquake debris management and the respective impact on public health and the environment.

5. Conclusions

Buildings and infrastructures in earthquake-affected areas are susceptible to significant and widespread structural and nonstructural damage. Earthquake debris mainly results from the collapse during the ground motion of the earthquake and the emergency demolition of unstable and damaged buildings in the course of emergency response and rehabilitation.

Several critical elements must be carefully considered during earthquake debris management. First and foremost, protecting public safety is critical. Debris removal from streets, public places, and residential areas should be prioritized in order for emergency services to reach affected people as quickly as possible. Assessing and mitigating possible debris-related hazards is critical in order to protect both rescuers and survivors from additional hazards and risks since hazardous debris elements pose threats to both the natural environment and public health in an earthquake-affected area.

Measures to reduce or eliminate the risks arising from earthquake debris management include the preparation and implementation of a flexible debris management plan that must take into account and adapt to the earthquake parameters and the demographic characteristics of the affected area, the adoption of safety precautions for all those participating in the debris management processes, the dissemination of information to the affected population, and the systematic monitoring of environmental parameters.

To reduce the harmful impact on the environment, proper debris removal and recycling should be addressed. When possible, salvaging and reusing items can help decrease waste and lessen the burden on resources. To ensure ecologically acceptable procedures are followed, it is critical to design and implement legislation and standards for earthquake debris disposal.

Earthquake debris management is a complex process that requires planning, implementation, and evaluation of relevant actions and measures, as well as the communication and cooperation among several stakeholders and agencies at different levels of governance. Transparency and collaboration may be improved by establishing open lines of communication, exchanging data on debris removal efforts and progress, and incorporating regional communities in decision-making procedures. Regular updates on debris management plans and progress can also provide reassurance and instill confidence in the recovery efforts.

Communities can effectively deal with the challenging task of earthquake debris management with more resilience and efficiency by emphasizing public safety, environmental concerns, and effective collaboration proposed in the frame of this review.