eyjafjallajökull eruption 2010 case study

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Eyjafjallajokull Case Study

What is eyjafjallajokull.

Eyjafjallajokull is a volcano located in Iceland. The name is a description of the volcano with Eyja meaning island; fjalla meaning mountain; and jokull meaning glacier. You can find out how to pronounce Eyjafjallajokull on the BBC website .

Eyjafjallajökull consists of a volcano completely covered by an ice cap. The ice cap covers an area of about 100 square kilometres (39 sq mi), feeding many outlet glaciers.

What type of volcano is Eyjafjallajokull?

The mountain itself, a composite (stratovolcano) volcano, stands 1,651 metres (5,417 ft) at its highest point and has a crater 3–4 kilometres (1.9–2.5 mi) in diameter, open to the north.

When did Eyjafjallajokull erupt?

Eyjafjallajokull erupted between March to May 2010.

Why did Eyjafjallajokull erupt?

Iceland lies on the Mid Atlantic Ridge, a constructive plate margin separating the North American Plate and the Eurasian plate. The two plates are moving apart due to ridge push along the Mid-Atlantic Ridge. As the plates move apart, magma fills the magma chamber below Eyjafjallajokull. Several magma chambers combined to produce a significant volume of magma below the volcano. Eyjafjallajokull is located below a glacier.

The Eyjafjallajökull volcano erupted in 920, 1612 and again from 1821 to 1823 when it caused a glacial lake outburst flood (or jökulhlaup). It erupted three times in 2010—on 20 March, April–May, and June. The March event forced a brief evacuation of around 500 local people. Still, the 14 April eruption was ten to twenty times more powerful and caused substantial disruption to air traffic across Europe. It caused the cancellation of thousands of flights across Europe and to Iceland.

How big was the eruption of Eyjafjallajokull?

The eruption was only three on the volcanic explosivity index (VEI). Around 15 eruptions on this scale usually happen each year in Iceland. However, in this case, a combination of a settled weather pattern with winds blowing towards Europe, very fine ash and a persistent eruption lasting 39 days magnified the impact of a relatively ordinary event. The eruptions in March were mainly lava eruptions. On 14 April, a new phase began, which was much more explosive. Violent eruptions belched huge quantities of ash into the atmosphere.

The eruption of Eyjafjallajokull

What were the impacts of the eruption? (social / economic / environmental – primary and secondary effects)

Primary effects : As the result of the eruption, day turned to night, with the ash blocking out the sun. Rescuers wore face masks to prevent them from choking on the clouds of ash.

Homes and roads were damaged and services disrupted, crops were destroyed by ash and roads washed away. The ash cloud brought European airspace to a standstill during the latter half of April 2010 and cost billions of euros in delays. During the eruption, a no-fly zone was imposed across much of Europe, that meant airlines were losing around £130m per day. The price of shares in major airlines dropped between 2.5-3.3% during the eruption. However, it should be noted that both imports and exports are being impacted across countries in Europe on the trade front, so the net trade position was not affected markedly overall.

Secondary effects : Sporting events were cancelled or affected due to cancelled flights. Fresh food imports stopped, and industries were affected by a lack of imported raw materials. Local water supplies were contaminated with fluoride. Flooding was caused as the glacier melted.

International Effects: The impact was felt as far afield as Kenya, where farmers have laid off 5000 workers after flowers and vegetables were left rotting at airports. Kenya’s flower council says the country lost $1.3m a day in lost shipments to Europe. Kenya exports typically up to 500 tonnes of flowers daily – 97% of which is delivered to Europe. Horticulture earned Kenya 71 billion shillings (£594m) in 2009 and is the country’s top foreign exchange earner. You can read more about this on the Guardian website .

What opportunities did the eruption of Eyjafjallajokull bring?

Despite the problems caused by the eruption of Eyjafjallajokull, the eruption brought several benefits. According to the Environmental Transport Association, the  grounding of European flights prevented some 2.8 million tonnes of carbon dioxide into the atmosphere (according to the Environmental Transport Association).

As passengers looked for other ways to travel than flying, many different transport companies benefited. There was a considerable increase in passenger numbers on Eurostar. It saw a rise of nearly a third, with 50,000 extra passengers travelling on their trains.

Ash from the Eyjafjallajökull volcano deposited dissolved iron into the North Atlantic, triggering a plankton bloom, driving an increase in biological productivity.

Following the negative publicity of the eruption, the Icelandic government launched a campaign to promote tourism . Inspired by Iceland was established with the strategic intent of depicting the country’s beauty, the friendliness of its people and the fact that it was very much open for business. As a result, tourist numbers increased significantly following the campaign, as shown in the graph below.

Foreign visitor arrivals to Iceland

What was done to reduce the impact of the eruption of Eyjafjallajokull?

In the short term, the area around the volcano was evacuated.

European Red Cross Societies mobilised volunteers, staff and other resources to help people affected directly or indirectly by the eruption of the Eyjafjallajökull glacier volcano. The European Red Cross provided food for the farming population living in the vicinity of the glacier, as well as counselling and psychosocial support, in particular for traumatised children. Some 700 people were evacuated from the disaster zone three times in the past month. In one instance, people had to flee their homes in the middle of the night to escape from flash floods.

The European Union has developed an integrated structure for air traffic management. As a result, nine Functional Airspace Blocks (FABs) will replace the existing 27 areas. This means following a volcanic eruption in the future, areas of air space may be closed, reducing the risk of closing all European air space.

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Eyjafjallajokull 2010 volcanic eruption case study

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This award-winning geography case study video resource reflects on the eruption of Eyjafjallajokull in 2010 and looks ahead to potential volcanic eruptions in Iceland.

In this video, we cover:

- The causes and impacts of the eruption, with visits to some of the localities directly affected - Volcano monitoring and preparedness - The impacts associated with the future eruption of Katla - Positive impacts of the volcanic eruption on tourism in Iceland

This teaching resource uses narrative, incisive interviews of local people, stunning archive footage of the eruption itself and supportive maps and diagrams to show that, through detailed scientific knowledge and monitoring, the people in Iceland not only understand the threats posed by volcanic eruptions but also see the rich benefits of living in the ‘Land of Fire and Ice’.

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• Published: 17 November 2010

Intrusion triggering of the 2010 Eyjafjallajökull explosive eruption

• Freysteinn Sigmundsson 1 ,
• Sigrún Hreinsdóttir 1 ,
• Andrew Hooper 2 ,
• Thóra Árnadóttir 1 ,
• Rikke Pedersen 1 ,
• Matthew J. Roberts 3 ,
• Níels Óskarsson 1 ,
• Amandine Auriac 1 ,
• Judicael Decriem 1 ,
• Páll Einarsson 1 ,
• Halldór Geirsson 3 ,
• Martin Hensch 1 ,
• Benedikt G. Ófeigsson 1 ,
• Erik Sturkell 4 ,
• Hjörleifur Sveinbjörnsson 3 &
• Kurt L. Feigl 5  

Nature volume  468 ,  pages 426–430 ( 2010 ) Cite this article

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• Environmental sciences
• Volcanology

Gradual inflation of magma chambers often precedes eruptions at highly active volcanoes. During such eruptions, rapid deflation occurs as magma flows out and pressure is reduced 1 , 2 , 3 . Less is known about the deformation style at moderately active volcanoes, such as Eyjafjallajökull, Iceland, where an explosive summit eruption of trachyandesite beginning on 14 April 2010 caused exceptional disruption to air traffic, closing airspace over much of Europe for days. This eruption was preceded by an effusive flank eruption of basalt from 20 March to 12 April 2010. The 2010 eruptions are the culmination of 18 years of intermittent volcanic unrest 4 , 5 , 6 , 7 , 8 , 9 . Here we show that deformation associated with the eruptions was unusual because it did not relate to pressure changes within a single magma chamber. Deformation was rapid before the first eruption (>5 mm per day after 4 March), but negligible during it. Lack of distinct co-eruptive deflation indicates that the net volume of magma drained from shallow depth during this eruption was small; rather, magma flowed from considerable depth. Before the eruption, a ∼ 0.05 km 3 magmatic intrusion grew over a period of three months, in a temporally and spatially complex manner, as revealed by GPS (Global Positioning System) geodetic measurements and interferometric analysis of satellite radar images. The second eruption occurred within the ice-capped caldera of the volcano, with explosivity amplified by magma–ice interaction. Gradual contraction of a source, distinct from the pre-eruptive inflation sources, is evident from geodetic data. Eyjafjallajökull’s behaviour can be attributed to its off-rift setting with a ‘cold’ subsurface structure and limited magma at shallow depth, as may be typical for moderately active volcanoes. Clear signs of volcanic unrest signals over years to weeks may indicate reawakening of such volcanoes, whereas immediate short-term eruption precursors may be subtle and difficult to detect.

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Acknowledgements

We acknowledge the efforts of Th. Jónsson, J. Hólmjárn, S. Steinthórsson, H. Ólafsson, Th. Ingvarsson and B. Brandsdóttir in making field operations run smoothly, as well as consultation and discussions with the staff of our institutes. We thank P. Segall and C. Wicks for comments on the manuscript, and NASA/GSFC for use of the MODIS image. Financial support for this work was received from the Icelandic Research Fund, the research fund at the University of Iceland, and the US National Science Foundation (grant EAR 1042103). Funds were received for hazard mitigation from the Icelandic government. We thank the Geodesy Laboratory at the University of Arizona for computing facilities and UNAVCO for technical support. GMT public domain software was used for some figures. TerraSAR-X data were provided by the German Space Agency under project number GEO0609.

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Nordic Volcanological Center, Institute of Earth Sciences, University of Iceland, Askja, Sturlugata 7, Reykjavik IS-101, Iceland,

Freysteinn Sigmundsson, Sigrún Hreinsdóttir, Thóra Árnadóttir, Rikke Pedersen, Níels Óskarsson, Amandine Auriac, Judicael Decriem, Páll Einarsson, Martin Hensch & Benedikt G. Ófeigsson

Delft Institute of Earth Observation and Space Systems, Delft University of Technology, Kluyverweg 1, 2629 HS, Delft, The Netherlands,

Andrew Hooper

Icelandic Meteorological Office, Bustadavegur 9, IS-150 Reykjavik, Iceland,

Matthew J. Roberts, Halldór Geirsson & Hjörleifur Sveinbjörnsson

Department of Earth Sciences, University of Gothenburg, Box 460, SE-405 30 Gothenburg, Sweden,

Erik Sturkell

Department of Geoscience, University of Wisconsin-Madison, 1215 W. Dayton St., Madison, 53706, Wisconsin, USA

Kurt L. Feigl

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Contributions

F.S. coordinated the writing of the paper and the research it is based on; S.H. and F.S. supervised the installation of new semi-continuous GPS stations; A.H. formed the interferograms and modelled the joint geodetic dataset; S.H. analysed the GPS data and produced the GPS time series; T.Á. modelled the GPS displacements; A.H., F.S., K.L.F. and R.P. planned the InSAR data acquisitions; S.H., M.J.R., A.A., H.G., M.H., B.G.Ó., H.S., E.S., P.E. and F.S. did the GPS measurements; N.Ó. conducted the geochemical analysis; P.E. has been involved in monitoring the volcano since 1971; M.J.R., S.H., R.P., P.E., N.Ó and F.S. were involved in daily monitoring of the eruptive activity; J.D. unwrapped the interferograms; K.L.F. formed additional interferograms and modelled them; A.H., R.P., S.H. and J.D. produced the figures; F.S., A.H., S.H., T.Á., R.P., N.Ó, P.E. and K.L.F. led the writing of the paper, with all authors commenting on and discussing its results.

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Correspondence to Freysteinn Sigmundsson .

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Sigmundsson, F., Hreinsdóttir, S., Hooper, A. et al. Intrusion triggering of the 2010 Eyjafjallajökull explosive eruption. Nature 468 , 426–430 (2010). https://doi.org/10.1038/nature09558

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Received : 14 May 2010

Accepted : 05 October 2010

Published : 17 November 2010

Issue Date : 18 November 2010

DOI : https://doi.org/10.1038/nature09558

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Eyjafjallajökull 2010: How Icelandic volcano eruption closed European skies

Ten years ago the Icelandic volcano Eyjafjallajökul erupted, sending a plume of volcanic ash over nine kilometers into the sky. 

The eruption was relatively small but its impact was massive. Europe experienced air travel chaos for almost one month as much of the continent ground to a standstill.

Eyjafjallajökul’s eruption remains one of the most memorable events of the twenty-first century and is also one of the defining moments for our aircraft research team, who played a key role in reopening European air space.

The Eyjafjallajökul eruption

The ice-capped volcano started to erupt in mid-March, following several months of increased seismic activity in Iceland. 

The first eruptions were isolated on the North-East flank, but problems started to arise in April when the eruptions spread to the centre of the volcano, a three kilometer-wide crater surrounded by ice.

As the ice started to melt, glacial water began flooding into the volcano where it met the bubbling magma at the centre of the eruptions. This rapid cooling caused the magma to shear into fine, jagged ash particles.  

Large plumes of volcanic ash quickly spread above the volcano, moving eastwards with the jetstream towards the Faroe Islands, Norway, and northern Scotland.

Iceland responded by declaring a state of emergency and European airspace was closed as a safety precaution. It is estimated that airlines lost an estimated £130m every day that airspace remained closed, while millions of passengers were left stranded. 

In order to reopen air space and reduce the economic impacts and disruption to travellers, the National Centre for Atmospheric Science was called in to map the volcanic plume. 

Mapping the plume from the air and the ground

The ash plume contained large amounts of microscopic particles of hard volcanic rock , which can cause serious damage to any aircraft flying through. These rock particles are incredibly hard to detect as they do not show up on radar images. 

Scientists from the National Centre for Atmospheric Science worked closely with the Civil Aviation Authority and the Met Office to track the plume and its contents using scientific instruments fitted to two research aircraft, alongside a series of computer models. 

The Facility for Airborne Atmospheric Measurement aircraft was fitted with a special instrument that uses a laser to illuminate the ash particles from above. Another aircraft, a Dornier, flew below the plume to help map the ash.

The two aircraft were able to fly where commercial airlines could not, due to their ability to detect the volcanic plume via the research instruments on board. 

To sample different layers of the plume, the aircraft flew up and down at heights between two and six kilometers. Meanwhile, scientists on the ground used computer models to build a picture of how the plume was moving. 

“We used the NOAA HYSPLIT model to track the dispersion of the volcanic plume.” says Professor Stephen Mobbs, Executive Director of the National Centre for Atmospheric Science.

“This model tracks the trajectories of atmospheric pollutants from sources, using the observed wind fields as interpreted by global weather forecasting models.”

Dangers of volcanic ash to aircraft

Our response to the environmental emergency was pivotal in enabling passenger aircraft to return safely to the skies.

The volcanic ash was electrically conductive which meant it could cause thunder and lightning, or St Elmo’s Fire – an effect where metal parts of an aircraft start to glow. The airspeed indicator – which is essential for safe flight – can also be adversely affected making control of the aircraft very difficult. Dust is also likely to enter the aircraft, causing sulphurous smells and haze. Professor Guy Gratton, Cranfield University

Professor Guy Gratton, Associate Professor in Aviation and the Environment at Cranfield University, says that volcanic ash could cause plane engines to seize:

“As they touch the aircraft, and particularly the engines, the hard rock particles can wear away the skin of an aircraft, its windscreens, and engine components. At the high temperatures inside a jet engine the particles can potentially block fuel nozzles or even melt and then solidify in other parts of the engine causing mishandling or engine stoppage.”

Future environmental emergencies

After the Eyjafjallajökul eruption, Professor Stephen Mobbs and Dr Susan Loughlin, Head of Volcanology at the British Geological Survey, were appointed to advisory groups set up by the UK government to respond to similar environmental emergencies in future. 

Researchers continue to watch Iceland’s volcanoes, and have since returned on a mission to monitor gases – including carbon dioxide and sulphur dioxide – over the potentially most active volcanoes. 

Recently, there have been peaks in these warning gases, which can indicate an eruption is on the way. There are several large volcanoes in Iceland, and when they erupt they are likely to have considerable effects across western Europe and beyond. One is Katla, which last erupted in 1918 and is widely considered to be overdue for an eruption.

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• v.2(2); 2012

A survey of early health effects of the Eyjafjallajökull 2010 eruption in Iceland: a population-based study

Hanne krage carlsen.

1 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland

Thorarinn Gislason

2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland

3 Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland

Bryndis Benediktsdottir

Thorir bjorn kolbeinsson.

4 Primary Health Care Centre of South Iceland, Hella, Iceland

Arna Hauksdottir

Throstur thorsteinsson.

5 Environment and Natural Resources and Institute of Earth Sciences, University of Iceland, Reykjavik, Iceland

Haraldur Briem

6 Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland

Associated Data

To estimate physical and mental health effects of the Eyjafjallajökull volcanic eruption on nearby residents.

Cross-sectional study.

The Icelandic volcano Eyjafjallajökull erupted on 14 April 2010. The eruption lasted for about 6 weeks and was explosive, ejecting some 8 million tons of fine particles into the atmosphere. Due to prevailing winds, the ash spread mostly to the south and south-east, first over the rural region to the south, later over the Atlantic Ocean and Europe, closing European air space for several days.

Participants

Residents (n=207) of the most ash-exposed rural area south and east of the volcano.

The study period was from 31 May to 11 June 2010. Participants were examined by a physician. To ascertain respiratory health, standardised spirometry was performed before and after the use of a bronchodilator. All adult participants answered questionnaires about mental and physical health, their children's health and the use of protective equipment.

Every other adult participant reported irritation in eyes and upper airway when exposed to volcanic ash. Adults (n=26) and children (n=5) with pre-existing asthma frequently reported worsening of their symptoms. No serious health problems requiring hospitalisation could be attributed to the eruption. The majority of the participants reported no abnormal physical or mental symptoms to the examining physician. Compared to an age- and gender-matched reference group, the ash-exposed participants reported lower smoking rates and were less likely to have ventilation impairment. Less than 10% of the participants reported symptoms of stress, anxiety or depression.

Conclusions

Short-term ash exposure was associated with upper airway irritation symptoms and exacerbation of pre-existing asthma but did not contribute to serious health problems. The exposure did not impair respiratory function compared to controls. Outdoor use of protective glasses and face masks was considered protective against irritation in eyes and upper airway.

Article summary

Article focus.

• Exposure to volcanic ash and gases can have adverse effects on respiratory health.
• Natural hazards, such as volcanic eruptions, can be stressful events.
• Value of preventive measures for those exposed to a volcanic eruption.

Key messages

• The short-term effects of ash exposure were associated with irritation in eyes and upper airway and exacerbation of pre-existing asthma but did not contribute to serious health problems or impair respiratory function as compared to controls.
• Participants with pre-existing respiratory and mental conditions need special attention and are more prone to developing symptoms following exposure to volcanic eruptions and volcanic ash.
• The use protective glasses and face masks prevented or relieved irritation symptoms from the eyes and upper airway.

Strengths and limitations of this study

• The whole population living within a confined area close to the volcano was contacted, and the response rate was high (93%) minimising the risk of selection bias, though some sensitive individuals had probably left the area, and some older individuals did not participate in the survey.
• Standardised methods were used in measuring respiratory function, and questionnaires were also standardised, allowing for comparisons with other studies.
• Results from the spirometry were compared to those from an age- and gender-matched Icelandic control group from a previous study, which had been performed using identical methods.
• The population was small (N=207), and due to stressful circumstances during the test period, not all participants completed the questionnaire, which limited the statistical power of our analyses.

Introduction

On 14 April 2010, an explosive summit crater eruption began in Eyjafjallajökull (Eyjafjalla Glacier), a volcano that is situated in south Iceland ( figure 1 ). In the early phases of the eruption, fine-grained ash was ejected up to 10 km into the atmosphere, disturbing air traffic in Europe for days. In Iceland, the rural regions south and south-east of the volcano were heavily exposed to falling ash. The volcano ejected some 250 million tons of ash, of which 8 million tons of particles were 2.8–28 μm in diameter. 1–5 Particles with a diameter of <10 μm are inhalable and can compromise respiratory health. Despite the falling ash that changed day to night, many inhabitants, mostly farmers, remained in the area to work on their farms and tend their livestock.

Map of the study area, which reached from just west of Eyjafjallajökull to Vík in the east. The shading illustrates duration and intensity of the ash plume. The darkest areas represent an estimated ash deposition of >500 g/m 2 , and around Vík, the deposition is estimated around 200 g/m 2 .

Apart from the immediate life-threatening hazards following a volcano eruption, such as pyroclastic flows, mudslides and glacial outburst floods, several other health risks are associated with living close to an active volcano. 6 Short-term exposure to volcanic gases can trigger asthma attacks and has been associated with respiratory morbidity and mortality and increased irritation of the respiratory tract. 7 Exposures for longer time periods to volcanic ash and gases have been associated with increases in cardiovascular symptoms 8 and increased rates of chronic bronchitis and other respiratory symptoms, 9 10 also in children. 11 Symptoms of skin and eye irritation have also been reported. 12 The chemical and physical properties of volcanic ash vary a great deal between eruptions and volcanoes, making it difficult to generalise about the toxicity of ash from individual eruptions. 12

Volcanic eruptions are violent natural disasters that impose a threat to health as well as to livestock and property. During eruptions, the population may have to be evacuated, depending on risk assessment, and uncertainty and stress experienced during the eruption can influence mental well-being. 13 14 The aims of this study were to examine medically the most exposed population and to evaluate possible acute physical and mental health effects associated with the Eyjafjallajökull eruption. In addition, the effectiveness of protective measures taken against inhaling ash and eye exposure was evaluated by asking the participants for their subjective experience of the measures.

The study area of the volcanic eruption

The volcanic eruption of the Eyjafjallajökull volcanic system began on 20 March 2010 with a small flank eruption, which produced negligible ash. After a day of no volcanic activity, an eruption started within the Eyjafjallajökull caldera on 14 April. 15 This phase was explosive, sending fine-grained, phreatomagmatic ash into the atmosphere. The eruption lasted some 6 weeks, until the end of May 2010. Ash exposure around the volcano was estimated using information about the eruption plume from satellite images (coarse time resolution), information about the emission intensity, 1 and information from observations on the ground. 16 Model calculations using FLEXPART 5 gave similar distribution for the deposited ash, with maximum deposition around 1000 g/m 2 (near the vent of the volcano) and about 200 g/m 2 near Vík. 4 During that time, the wind direction was predominantly west and north-west, therefore most of the ash fall was to the south and south-east of the volcano ( figure 1 ). In this study, we included inhabitants of the area between the River Markarfljót and the village of Vík as they were most exposed. Most inhabitants are farmers, and many also have income from tourism.

The volcanic ash

The ash was trachyandesitic, 58% silica by mass, but contained very little quartz, and no cristobalite was detected. 1–5 In ash samples collected during the first 3 days of the eruption, upwards of 25% of particles by mass were <10 μm in diameter (PM 10 ) and therefore inhalable. The fraction of fine particles was lower for ash ejected later in the eruption, 1 but still the amount of ash produced was considerable, and the fine-grained ash was also easily resuspended. The concentration of airborne particulate matter frequently exceeded the WHO guideline values for PM 10 during the eruption. 4

A network of diffusion tubes in the ground area showed no evidence of fumigation by sulphur dioxide, the predominant volcanic gas in the ash plume, in the last 3 weeks of the eruption (Personal communication: Peter Baxter, 2010).

Target population and recruitment

During the eruption, some 223 individuals lived in the study area and were exposed to ash fall. All the inhabitants were invited to a medical examination during the time period 31 May–11 June 2010. An announcement was put up in local official buildings and information given on radio and TV news. Also, inhabitants were contacted by telephone by staff from the two local primary healthcare centres in the area. The majority of participants were examined at temporary medical offices at a community centre or at a primary healthcare centre; a few were examined in their homes.

Medical and psychological examination

A physician interviewed and examined all participants. The physicians in charge were specialists in family medicine and respiratory medicine. Former and present physical and psychological health was explored. Participants were asked if they experienced any change in health or new symptoms that they related to the ash and the volcanic eruption. The medical history of young children was obtained from their parents. In case of abnormal findings, the participants were referred to their Primary Health Care Centre for further examination and treatment.

The forced expiratory volume in one second (FEV 1 ) and the forced vital capacity (FVC) values were obtained by spirometry in all participants 5 years or older, according to the American Thoracic Society criteria in the same way and by the same fieldworkers as had conducted the Burden of Obstructive Lung Disease (BOLD) multicentre study in Iceland. 17 18 The spirometry was conducted by trained and certified personnel, and the medical examination was conducted by doctors, all from the Landspitali University Hospital.

Briefly, testing was conducted with the participant in a sitting position wearing a nose clip and a disposable mouthpiece using the NDD Easy One spirometer (NDD Medizintechnik, Zurich, Switzerland). Prebronchodilator and postbronchodilator tests were carried out, with separate measurements performed before and ≥15 min after two puffs of salbutamol (200 μg). The primary reference equations used are derived from the third United States National Health and Nutrition Examination Survey (NHANES III) for adult Caucasians. 19

The criteria for chronic obstructive pulmonary disease (COPD) are defined by the Global Initiative of Chronic Obstructive Lung Disease. 17 COPD GOLD stage I was defined as FEV 1 /FVC ratio <0.7 after bronchodilation and GOLD stage II as FEV 1 /FVC ratio <0.7 and FEV 1 ≤80% predicted after bronchodilation. Reversibility of airway obstruction was calculated as a change in FEV 1 and expressed as a change in percentage (∆%).

For analysis of the spirometry results in those older than 40 years, a subset of the BOLD cohort 18 was used as a control group, with three age- and gender-matched controls from the BOLD (random general) population for each participant exposed to volcanic ash.

Questionnaires

Participants older than 18 years were asked to fill out questionnaires with questions about physical health, mental health, exposure to volcanic ash, experience of earthquakes, rumbling and smell from the volcano, and use of protective face masks and glasses. If necessary, the questionnaires were read to them by researchers.

Respiratory health before the eruption was assessed by the European Community Respiratory Health Survey (ECRHS) II Questionnaire. 20 From the main ECRSH Questionnaire, we used questions about wheeze, cough and phlegm prevalence, history of respiratory- and heart disease (questions number 1–3, 6–10 and 14, and question 7 from the screening questionnaire).

The participants were also asked if they had experienced other respiratory or eye symptoms, muscular pain, fatigue, nausea, headache, stomach pain or insomnia before and/or after the eruption started. If the symptoms had started after the eruption, they were asked to quantify how much these symptoms affected their daily life on a 3-point scale (rather little, rather much and very much).

Parents answered seven questions about respiratory symptoms, headache, stomach ache, insomnia, anxiety, depression and behavioural changes in children younger than 18 years. If these symptoms had started after the eruption, they were asked to quantify them on a three-level scale.

There were also questions about medical emergencies, use of medication, injuries, and accidents related to the eruption.

Mental health was assessed with three different psychometric scales, which all had previously been translated into Icelandic and used in other studies. When measuring psychological morbidity in relationship with the eruption, we used the General Health Questionnaire (GHQ-12), 21 22 the Depression Anxiety Stress Scale (DASS), 23 and the Post-Traumatic Stress Disorder (PTSD) Symptom Scale, Self-Report version (PSS-SR). 24 25 Each questionnaire was evaluated, and, if inadequately answered, excluded.

For GHQ-12, a score of more than 2 was considered indicative of experiencing more mental distress than usual (Bimodal score). 21

For PSS-SR, a score of more than 14 considered indicative of likelihood of PTSD symptoms in the participants. 24 25

For DASS, a score was given for each of the three dimensions addressed in the questionnaire. A score of more than 10 for depression, 8 for anxiety, and 15 for stress indicated symptom severity, from mild to extreme, as defined by Lovibond and Lovibond. 23 DASS and PSS-SR questionnaires were not administered on the first day of the study, but participants were given the option of filling out the questionnaires and mailing them.

Participants were asked how they had experienced ash fall, heard or been awakened by noise from the volcano, felt earthquakes, smell or limited vision outside due to ash fall at their homes; how many days they had to stay inside because of ash fall; how many hours they usually worked outdoors and if they had used protective equipment. Finally, participants were asked if they had received help or services from a number of organisations and institutions, and if they were satisfied with it.

Smoking history was investigated by asking participants if they had ever smoked, and if they were current smokers. Based on this information, the participants were classified into never-smoker, former smoker and current smoker.

Statistical analysis

All data were entered into a database by one observer. The analysis was mainly descriptive, and the primary outcome measure was prevalence in percentage (%) of the total number of answers in the given category. In comparisons between groups, we used Student t test and χ 2 test. Individuals with incomplete data were not excluded from the study, but non-replies to any single questions were excluded from individual analyses. We used SPSS software V.18 26 and R. 27

Altogether 207 out of 223 individuals (93%) who lived in the study area at the time of the eruption participated in the study. Local health workers, who recruited the participants, reported that inhabitants of two of about 80 farms had refused to participate, and 14 individuals who had initially signed up did not participate.

The most common reason for non-participation reported to the recruiters was either ‘being busy’, ‘not having any health problems’ or ‘old age’ (reported by relatives). Of the 207 participating residents, 40 were younger than 18 years. Most of them, 202 (98%) were medically examined, 164 adults and 38 children. The same proportion was tested with spirometry, and 156 adults were tested both before and after bronchodilation. All adults received questionnaires about symptoms and general health (GHQ-12). PSS-SR and DASS were administered to 150 people. Main demographic characteristics, symptom, and smoking rates reported by adults are shown in table 1 . The survey included 40 children younger than 18 years, of which 21 (53%) were girls.

Demographic characteristics and questionnaire-reported symptoms of participants who all lived close to the Eyjafjallajökull volcano (n=167)

BMI, body mass index; COPD, chronic obstructive pulmonary disease.

The age distribution of all participants is given in figure 2 .

Age distribution of the study participants (n=207) from the Eyjafjallajökull area investigated from 31 May to 11 June 2010.

Physical examination

The physician's judgement was that 126 (62%) of the participants were healthy. In the physician interview, 26 (13%) of adults reported history of asthma or other chronic respiratory diseases, 32 (16%) reported symptoms and signs other than respiratory and 27 (13%) participants indicated a history of mental symptoms. Asthma rates reported to physicians were similar to those reported in questionnaires. Of those with a history of asthma or other respiratory diseases, 38% had a normal spirometric test, but 39% reported worsening of the disease when exposed to ash ( table 1 ). Some reported to physicians that upper respiratory symptoms subsided when avoiding exposure by staying inside, wearing dust masks, and also that falling ‘fresh’ ash was more bothersome than ‘older’ ash re-suspended by wind. Farming was reported as the main occupation (63%) of adult participants.

Among the 202 participants who underwent spirometry, 37 (18%) were found to have impaired respiratory function by the examining physician.

Participants aged 40 years or older had on average a higher FEV 1 than the reference group (p=0.003), and they also showed less airflow reversibility (p<0.0001). The rates of chronic cough and phlegm were similar in the study participants and the reference group (8%–10%). Smoking was more common in the reference group than the volcano-exposed participants (p<0.01). After bronchodilation, 20% of those aged 40 years or older fulfilled the criteria for COPD stage I or higher, which was identical to that found among the general population reference group ( table 2 ). 18

Spirometry results, smoking status, reported chronic respiratory diseases and symptoms among participants aged >40 years compared to an age- and gender-matched reference group from the general population

∆FEV 1 , increase in FEV 1 % predicted after use of bronchodilation; COPD, chronic obstructive pulmonary disease; FEV 1 , forced expiratory volume in one second; FVC, forced vital capacity.

The 35 children who were tested with spirometry had a normal per cent of predicted FEV 1 (102%±19%; mean, one SD) and FVC (104%±17%). Altogether four had FEV 1 % predicted lower than 85%; two of these had pre-existing asthma and revealed symptoms when examined (FEV 1 48% and 76%, respectively), the other two were previously healthy, but both had symptoms of upper airway virus infection (FEV 1 71% and 81%, respectively) when examined.

Almost half of the adult participants (43%) experienced symptoms from the upper airways and eyes during the ash fall. Almost everybody or 153 of 161 (96%) found facial mask and glasses protective against respiratory and eye symptoms when staying outdoor during ash fall. All participants of the study were exposed to ash fall at their homes, and almost all (88%) had to stay inside at least 1 day and one third (34%) for 6 days or more, which may explain some of the mental distress and child behavioural problems. Also, avoiding exposure by staying in the well-isolated houses may have kept symptom rates down. Almost everyone (98%) had heard the explosions from the mountain at their home, and 53% had woken up at night because of noise, but there was no obvious geographical pattern to this. The most common self-reported symptoms in adult participants are shown in table 1 . Men and women had similar rates of symptoms, except that women tended to report more throat and upper airway irritation (p=0.06, Student t test).

Women reported more frequently mental health deterioration than men, according to the GHQ and DASS, and the highest rates were found in those between 35 and 49 years of age ( table 3 ). Symptoms of post-traumatic stress syndrome (PSS-SR) were found in 7% of participants and were more common among women than men and in those slightly older (50–64 years old). Very little effect on mental health was reported in the age group 18–34 years.

Mental symptoms following the eruption of Eyjafjallajökull

Table 4 shows the proportions of participants experiencing mental distress by level of exposure (experience of the volcanic eruption). Experiencing a feeling of helplessness or fear for the lives of others or oneself during the eruption period was associated with higher rates of likely PTSD symptoms. The frequency of mental distress (as measured by the GHQ) was significantly (p<0.05) higher in those who had been awakened by noise.

Mental symptoms and experiences during the eruption of Eyjafjallajökull

In all fractions the nominator refers to those who scored above the cut-off for the various scales.

Symptoms of depression and anxiety (DASS) were more common among those who had experienced earthquakes and had thought that their lives were in danger ( table 4 ).

Many children of school age were not in the area during the heaviest ash fall. A boarding school outside the affected region invited the Eyjafjallajökull children to stay for some weeks. By the time the health survey was carried out, most were in the area. Nevertheless, 13 (28%) of parents reported in the questionnaires that their child had experienced throat or upper airway irritation symptoms (data not shown). Eight (13%) reported headaches, while three parents (7%) reported that their child or children had had nausea or stomach pain during the eruption. Of the 40 participating children, five had a history of asthma and they all reported in the medical interview that they had had more symptoms during the ash fall and needed more antiasthmatic medication than usual. Regarding mental distress, 39% of participants with children reported increased worries or anxiety in their children, 18% reported increased behaviour problems and 16% reported sleep-related problems.

In a well-defined rural population that had been exposed to volcanic ash particles with a substantial inhalable fraction for several weeks during the Eyjafjallajökull eruption, we found only a small degree of physical health impairments soon after the eruption. No hospital admissions, fatalities or life-threatening or serious symptoms or diseases that could be attributed to the eruption were found in this study cohort. From the answers to the questionnaires, we could conclude that compared to the general population sample from the BOLD study, the study participants reported a similar prevalence of respiratory symptoms and obstructive lung disease. Some symptoms of mental distress were found in this study.

In our study, we contacted the whole population living closest to the volcano and had a high participation rate (93%). According to the recruiters, some non-participators reported not having any health problems, so the symptom rates presented here may be overestimated. There may also be a recall bias, so that those who are worried about their health are more likely to participate and recall symptoms. On the other hand, some vulnerable individuals may have chosen not to participate or had left the most affected area, which may cause us to underestimate the symptom rates.

To facilitate comparisons with other studies, we used standardised methods in both the medical examinations and questionnaires, as well as the spirometry in this survey. However, the population is small (N=207, of which 167 were adults) and due to stressful circumstances during the test period, not all participants completed the questionnaire, which limited the statistical power of our analyses.

The participants from the Eyjafjallajökull area had better lung function than the general population sample, most likely due to a much lower prevalence of smoking. They also had less obstructed airways when tested again after use of a bronchodilator, probably because those with asthma had already increased their bronchodilator treatment during the ash fall. Also, the general population reference sample lived in urban and suburban areas, whereas the Eyjafjallajökull area is predominantly rural. The children had normal spirometry measurements. Previous studies have not found changes in lung function in children after volcanic ash exposure, but asthma hospitalisation rates have been seen to increase after several eruptions, 11 12 and a dose–response has also been found in a Japanese study of asthmatic adults who were exposed to volcanic ash. 28

Intermittent symptoms in the eyes and upper respiratory organs were very common, but they could be prevented by wearing eye protection and face masks, or avoiding exposure by staying inside. Facial masks and glasses for eye protection were made widely and freely available by the public health authorities. These protective equipment were in plentiful supplies purchased for the swine flu epidemic the previous year. Icelandic houses are generally quite well insulated with windows that shut tightly and seemed to offer some protection.

It was recorded in several of the medical examination reports that people found the ash more irritating in the beginning of the eruption, perhaps because fresh ash particles can have chemical compounds on the surface, which are later washed away. 2 3

In a study of the ash from Eyjafjallajökull, Horwell et al 2 found most samples to have little potential for damaging health. The ash contained a negligible amount of crystalline silica, and though one sample showed some cytotoxicity in in vitro studies, the report concluded that the ash was unlikely to have an effect at the levels to which people were actually exposed.

The first results from a study of lung tissue samples and samples from the gastrointestinal tract of animals brought to slaughter from the affected area in the autumn of 2010 did not reveal any significant pathology. 29

During the first days of the eruption, precautions for individuals with respiratory disease were issued throughout much of Europe, both by national health authorities but also by the WHO. 30 Symptom surveillance studies, however, have shown a slight increase in the number of individuals on the European continent seeking medical help for certain symptoms in the period when the region was affected by ash. 31 32

In our study, 39% of participants reported some symptoms of mental distress, as measured by the GHQ. A high GHQ score was associated with feeling helpless or afraid or being awakened by noises from the volcano. The rate of GHQ cases in this study was more than twice as many as in a 2004 study of Icelandic farmers where 17% scored above the reference value for mental distress in the GHQ. 33 However, in a Japanese study of a population exposed to a volcanic eruption, 66% were found to suffer from mental distress, but this population had been evacuated and were unable to return to their home region for years. 14 Only half of the participants in this study population were evacuated, and then only for a few days.

The proportion of participants who exhibited symptoms of post-traumatic stress (7%) was similar to that found following a large earthquake in the south of Iceland in 2008. 34 When the eruption was still active, there were substantial disturbances in people's daily routine. Some of the fatigue and stress indicated by the high prevalence of mental distress may be attributed to the increased workload during the eruption and at the same time the uncertainty about one's own health, the health of others, the livestock and the future. In addition, our results showed that increased mental distress might partly be explained by the extent of experience of volcanic phenomena, as it was associated with having experienced earthquakes related to the eruption or experiencing threat to one's own life or that of others. On the other hand, those who are distressed may experience these phenomena more strongly during an eruption. Information about the possible health effects of the ash was needed for the affected individuals. Therefore, early in the eruption, collaboration was established with national as well as international experts from the WHO and EU, and the International Volcanic Health Hazards Network, whose pamphlets were translated into Icelandic and distributed widely. 35 Trauma response teams on behalf of the Red Cross were present in the evacuation and community centres, and a number of community meetings were held to inform the affected population.

During the time when volcanic ash was falling from the Eyjafjallajökull eruption, the majority of participants experienced symptoms from eyes and upper airways. Those with underlying obstructive lung disease were particularly vulnerable; half of the asthmatic adults and all the asthmatic children had more pronounced symptoms during the eruption.

Our results indicate that public health measures were effective in relieving symptoms. Recommendation to avoid exposure by either staying inside or wearing dust protection masks and glasses when outdoors during the ash fall or storms may have contributed to mitigation of irritation and symptoms.

During a volcanic ash fall, intensive medical attention should be aimed at vulnerable individuals with underlying respiratory diseases and known mental disorders.

Little is known about long-term health effects of exposure to volcanic ash, but continuous surveillance and research is necessary as the ash is likely to remain in the environment for some years to come. A follow-up study would be helpful in interpreting the spirometry results, but no severe health outcomes could be associated with the eruption in this study.

Supplementary Material

Acknowledgments.

We thank Olof Arnadottir and Helga Thorbergsdottir, RN, South Iceland Primary Health Care Centre; Berglind Gudmundsdottir, psychologist, Landspitali-University Hospital; Edda Bjork Thordardottir, PhD student, University of Iceland; Gudrun Pétursdottir, PhD, University of Iceland Centre for Sustainability Studies; Kristinn Tomasson, MD, Administration of Occupational Safety and Health in Iceland; Urdur Njardvik, lector in psychology, University of Iceland; Ossur Ingi Emilsson, Cand. Med., University of Iceland; Halldora Brynjolfsdottir, Hildur Ragnarsdottir, Kristin Bara Jorundsdottir and Sigrun Gudmundsdottir, research specialists, Landspitali-University Hospital; Elísabet Magnusdottir, research assistant, University of Iceland and Agust Gunnar Gylfason, project manager in risk management, Icelandic civil protection service for their assistance in conducting this study.

To cite: Carlsen HK, Gislason T, Benediktsdottir B, et al . A survey of early health effects of the Eyjafjallajökull 2010 eruption in Iceland: a population-based study. BMJ Open 2012; 2 :e000343. doi: 10.1136/bmjopen-2011-000343

Contributors: All authors were involved in designing the study, interpreting the results and drafting the article. TG and BB conducted the medical examinations, HKC and AH implemented the questionnaires, TBK recruited the participants, TT analysed the data on the ash and ash fall and HB initiated this study and collected all data.

Funding: Funded by the Ministry of Welfare. The Health Authorities.

Competing interests: None.

Patient consent: Obtained.

Ethics approval: Icelandic Health Authorities. According to Icelandic legislation (Act no. 19/1997 on Health Security and Communicable Diseases), incidents concerning public health threats are to be investigated without delay such as urgent outbreak investigations. Ethics approval may take some time and could not possibly be obtained before this investigation started.

Provenance and peer review: Commissioned according to the Act on Health Security and Communicable Disease Control No. 19/1997. Externally peer reviewed.

Data sharing statement: The authors are willing to share all available data. There are additional unpublished data on spirometric measurements available if requested.

• Effects on Aircraft
• Signs of an Encounter
• Actions for Flight Crew
• Global Mitigation
• Eyjafjallajökull Impact
• Resources & References

The 2010 eruption of Iceland's Eyjafjallajökull volcano had a huge impact on air travel, changing the assessment of risk by the aviation sector and catalyzing new lines of scientific investigation. Ash advisories derived from dispersion-model output were issued by the London VAAC, depicting the presence of ash over large parts of Europe and the North Atlantic. Based on those advisories, over 300 airports in about two dozen countries, and a correspondingly large airspace, were closed in Europe during 15-21 April 2010. This resulted in massive impacts on air travel worldwide. Over 100,000 flights were cancelled over that week, affecting 7 million passengers, and resulting in $1.7 billion USD in lost revenue to airlines according to an analysis by Oxford Economics.

To reopen airspace, European aviation authorities endorsed the creation of a new type of concentration chart advisory product that delineated hazard zones based on dispersion model output of ash concentrations. So called 'low' ash concentrations were deemed to be defined as 3 . The concentration charts were adopted by air traffic management and airlines with the expectation that zones of low density ash could be transited with no or minimal risk of immediate aircraft damage providing a regime of enhanced risk assessment by airlines, including more frequent aircraft inspections, was adopted. Currently, concentration charts have only been adopted for operational use in Europe and the North Atlantic region, as outlined in Volcanic Ash Contingency Plan EUR and NAT Regions . The scientific validity and operational utility of the ash concentration charts have been questioned by international experts and therefore have not been implemented outside Europe.

Also in response to Eyjafjallajökull's impact on air travel, ICAO formed the International Volcanic Ash Task Force (IVATF) in May 2010, charging it to examine how best to define hazardous airspace and manage aviation risk. The IVATF included representatives from government and industry groups involved in aviation regulation, operations, and scientific investigations. The IVATF finished its work in June 2012, and a record of its results is available.

On the scientific front, there has been a notable increase in volcanic-cloud research since Eyjafjallajökull and the Cordon Caulle long-lived ash plume of 2011. A burst of scientific articles has been published, including in special journal issues (Hasager et al, 2010; Langmann et al., 2012). Overall, these eruptions have prompted the aviation industry, regulators, and scientists to work more closely together to improve the manner in which hazardous airspace is defined, forecast, and communicated.

• Research Article
• Published: 29 April 2012

Residents' attitudes and behaviour before and after the 2010 Eyjafjallajökull eruptions—a case study from southern Iceland

• Deanne K. Bird 1 , 2 &
• Guðrún Gísladóttir 3  

Bulletin of Volcanology volume  74 ,  pages 1263–1279 ( 2012 ) Cite this article

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While the disruption to international air travel caused by the eruption of Iceland's Eyjafjallajökull volcano in 2010 has been well documented, the significant social impacts on local residents from ash fall to the south and east of the crater are less well-known. These impacts and attitudes of impacted residents and emergency managers are the foci of our present study. Prior to and during the eruption, officials worked to protect the local population from the glacial outburst floods (jökulhlaup) that were of primary concern. The success of these endeavours can in part be attributed to a regional evacuation exercise held in March 2006, an exercise that was carried out with respect to a possible eruption at another volcano, Katla, that is located 25 km to the east of Eyjafjallajökull. Eruptions at either volcano will impact the same communities. Our study here concentrates on Álftaver, a small farming community, located approximately 60 km east-southeast of Eyjafjallajökull and 30 km southeast of Katla. Álftaver has been the subject of longitudinal studies carried out in 2004, 2006, and 2008; these studies highlighted the difficulties that emergency managers face in developing appropriate response strategies acceptable to vulnerable communities. The 2010 Eyjafjallajökull eruptions presented an opportunity to re-assess residents' attitudes and behaviour in relation to volcanic risk management in the wake of their first-hand experiences with volcanic hazards. To achieve this, interviews were conducted with residents and emergency management officials and a questionnaire was distributed to residents. This paper presents the results of this survey and examines changes in attitudes towards volcanic risk management. It was apparent that the experience of ash fall from Eyjafjallajökull provided a better perspective of what could be expected from a Katla eruption and that attitudes towards emergency management had evolved accordingly. Importantly, officials' perceptions of risk are now more aligned with those of residents and both recognise the need for more detailed and concise information regarding the impacts of ash fall during and following volcanic eruptions.

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Acknowledgements

All respondents are graciously thanked for their willingness to participate in this investigation. Contributions from the Ash Fall Impacts Working Group, Katharine Haynes, Carolina Garcia Londoño, and Guðrún Pétursdóttir are appreciated in relation to the development of the questionnaire. Reviews on early drafts of this paper by Pat Bazeley, Benjamin Gillespie, and Katharine Haynes are also appreciated. Further gratitude is extended to the handling editor, Clive Oppenheimer, and two reviewers, Ilan Kelman and one anonymous, for providing insightful comments and detailed recommendations which helped improve the manuscript from the original. This work was financially supported by Rannís—the Icelandic Centre for Research (Research Grant #081260008) and Vegagerðin (The Icelandic Road Administration).

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Department of Geography & Tourism, Faculty of Life and Environmental Sciences, Earth Science Institute, University of Iceland, 101, Reykjavík, Iceland

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Bird, D.K., Gísladóttir, G. Residents' attitudes and behaviour before and after the 2010 Eyjafjallajökull eruptions—a case study from southern Iceland. Bull Volcanol 74 , 1263–1279 (2012). https://doi.org/10.1007/s00445-012-0595-z

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Received : 12 September 2011

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DOI : https://doi.org/10.1007/s00445-012-0595-z

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• Volume 2, Issue 2
• A survey of early health effects of the Eyjafjallajökull 2010 eruption in Iceland: a population-based study
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• Hanne Krage Carlsen 1 ,
• Thorarinn Gislason 2 , 3 ,
• Bryndis Benediktsdottir 2 , 3 ,
• Thorir Bjorn Kolbeinsson 4 ,
• Arna Hauksdottir 1 ,
• Throstur Thorsteinsson 5 ,
• Haraldur Briem 6
• 1 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
• 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
• 3 Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
• 4 Primary Health Care Centre of South Iceland, Hella, Iceland
• 5 Environment and Natural Resources and Institute of Earth Sciences, University of Iceland, Reykjavik, Iceland
• 6 Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
• Correspondence to Dr Haraldur Briem; hbriem{at}landlaeknir.is

Objective To estimate physical and mental health effects of the Eyjafjallajökull volcanic eruption on nearby residents.

Design Cross-sectional study.

Setting The Icelandic volcano Eyjafjallajökull erupted on 14 April 2010. The eruption lasted for about 6 weeks and was explosive, ejecting some 8 million tons of fine particles into the atmosphere. Due to prevailing winds, the ash spread mostly to the south and south-east, first over the rural region to the south, later over the Atlantic Ocean and Europe, closing European air space for several days.

Participants Residents (n=207) of the most ash-exposed rural area south and east of the volcano.

Methods The study period was from 31 May to 11 June 2010. Participants were examined by a physician. To ascertain respiratory health, standardised spirometry was performed before and after the use of a bronchodilator. All adult participants answered questionnaires about mental and physical health, their children's health and the use of protective equipment.

Results Every other adult participant reported irritation in eyes and upper airway when exposed to volcanic ash. Adults (n=26) and children (n=5) with pre-existing asthma frequently reported worsening of their symptoms. No serious health problems requiring hospitalisation could be attributed to the eruption. The majority of the participants reported no abnormal physical or mental symptoms to the examining physician. Compared to an age- and gender-matched reference group, the ash-exposed participants reported lower smoking rates and were less likely to have ventilation impairment. Less than 10% of the participants reported symptoms of stress, anxiety or depression.

Conclusions Short-term ash exposure was associated with upper airway irritation symptoms and exacerbation of pre-existing asthma but did not contribute to serious health problems. The exposure did not impair respiratory function compared to controls. Outdoor use of protective glasses and face masks was considered protective against irritation in eyes and upper airway.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode .

http://dx.doi.org/10.1136/bmjopen-2011-000343

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Article summary

Article focus.

Exposure to volcanic ash and gases can have adverse effects on respiratory health.

Natural hazards, such as volcanic eruptions, can be stressful events.

Value of preventive measures for those exposed to a volcanic eruption.

Key messages

The short-term effects of ash exposure were associated with irritation in eyes and upper airway and exacerbation of pre-existing asthma but did not contribute to serious health problems or impair respiratory function as compared to controls.

Participants with pre-existing respiratory and mental conditions need special attention and are more prone to developing symptoms following exposure to volcanic eruptions and volcanic ash.

The use protective glasses and face masks prevented or relieved irritation symptoms from the eyes and upper airway.

Strengths and limitations of this study

The whole population living within a confined area close to the volcano was contacted, and the response rate was high (93%) minimising the risk of selection bias, though some sensitive individuals had probably left the area, and some older individuals did not participate in the survey.

Standardised methods were used in measuring respiratory function, and questionnaires were also standardised, allowing for comparisons with other studies.

Results from the spirometry were compared to those from an age- and gender-matched Icelandic control group from a previous study, which had been performed using identical methods.

The population was small (N=207), and due to stressful circumstances during the test period, not all participants completed the questionnaire, which limited the statistical power of our analyses.

Introduction

On 14 April 2010, an explosive summit crater eruption began in Eyjafjallajökull (Eyjafjalla Glacier), a volcano that is situated in south Iceland ( figure 1 ). In the early phases of the eruption, fine-grained ash was ejected up to 10 km into the atmosphere, disturbing air traffic in Europe for days. In Iceland, the rural regions south and south-east of the volcano were heavily exposed to falling ash. The volcano ejected some 250 million tons of ash, of which 8 million tons of particles were 2.8–28 μm in diameter. 1–5 Particles with a diameter of <10 μm are inhalable and can compromise respiratory health. Despite the falling ash that changed day to night, many inhabitants, mostly farmers, remained in the area to work on their farms and tend their livestock.

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Map of the study area, which reached from just west of Eyjafjallajökull to Vík in the east. The shading illustrates duration and intensity of the ash plume. The darkest areas represent an estimated ash deposition of >500 g/m 2 , and around Vík, the deposition is estimated around 200 g/m 2 .

Apart from the immediate life-threatening hazards following a volcano eruption, such as pyroclastic flows, mudslides and glacial outburst floods, several other health risks are associated with living close to an active volcano. 6 Short-term exposure to volcanic gases can trigger asthma attacks and has been associated with respiratory morbidity and mortality and increased irritation of the respiratory tract. 7 Exposures for longer time periods to volcanic ash and gases have been associated with increases in cardiovascular symptoms 8 and increased rates of chronic bronchitis and other respiratory symptoms, 9 10 also in children. 11 Symptoms of skin and eye irritation have also been reported. 12 The chemical and physical properties of volcanic ash vary a great deal between eruptions and volcanoes, making it difficult to generalise about the toxicity of ash from individual eruptions. 12

Volcanic eruptions are violent natural disasters that impose a threat to health as well as to livestock and property. During eruptions, the population may have to be evacuated, depending on risk assessment, and uncertainty and stress experienced during the eruption can influence mental well-being. 13 14 The aims of this study were to examine medically the most exposed population and to evaluate possible acute physical and mental health effects associated with the Eyjafjallajökull eruption. In addition, the effectiveness of protective measures taken against inhaling ash and eye exposure was evaluated by asking the participants for their subjective experience of the measures.

The study area of the volcanic eruption

The volcanic eruption of the Eyjafjallajökull volcanic system began on 20 March 2010 with a small flank eruption, which produced negligible ash. After a day of no volcanic activity, an eruption started within the Eyjafjallajökull caldera on 14 April. 15 This phase was explosive, sending fine-grained, phreatomagmatic ash into the atmosphere. The eruption lasted some 6 weeks, until the end of May 2010. Ash exposure around the volcano was estimated using information about the eruption plume from satellite images (coarse time resolution), information about the emission intensity, 1 and information from observations on the ground. 16 Model calculations using FLEXPART 5 gave similar distribution for the deposited ash, with maximum deposition around 1000 g/m 2 (near the vent of the volcano) and about 200 g/m 2 near Vík. 4 During that time, the wind direction was predominantly west and north-west, therefore most of the ash fall was to the south and south-east of the volcano ( figure 1 ). In this study, we included inhabitants of the area between the River Markarfljót and the village of Vík as they were most exposed. Most inhabitants are farmers, and many also have income from tourism.

The volcanic ash

The ash was trachyandesitic, 58% silica by mass, but contained very little quartz, and no cristobalite was detected. 1–5 In ash samples collected during the first 3 days of the eruption, upwards of 25% of particles by mass were <10 μm in diameter (PM 10 ) and therefore inhalable. The fraction of fine particles was lower for ash ejected later in the eruption, 1 but still the amount of ash produced was considerable, and the fine-grained ash was also easily resuspended. The concentration of airborne particulate matter frequently exceeded the WHO guideline values for PM 10 during the eruption. 4

A network of diffusion tubes in the ground area showed no evidence of fumigation by sulphur dioxide, the predominant volcanic gas in the ash plume, in the last 3 weeks of the eruption (Personal communication: Peter Baxter, 2010).

Target population and recruitment

During the eruption, some 223 individuals lived in the study area and were exposed to ash fall. All the inhabitants were invited to a medical examination during the time period 31 May–11 June 2010. An announcement was put up in local official buildings and information given on radio and TV news. Also, inhabitants were contacted by telephone by staff from the two local primary healthcare centres in the area. The majority of participants were examined at temporary medical offices at a community centre or at a primary healthcare centre; a few were examined in their homes.

Medical and psychological examination

A physician interviewed and examined all participants. The physicians in charge were specialists in family medicine and respiratory medicine. Former and present physical and psychological health was explored. Participants were asked if they experienced any change in health or new symptoms that they related to the ash and the volcanic eruption. The medical history of young children was obtained from their parents. In case of abnormal findings, the participants were referred to their Primary Health Care Centre for further examination and treatment.

The forced expiratory volume in one second (FEV 1 ) and the forced vital capacity (FVC) values were obtained by spirometry in all participants 5 years or older, according to the American Thoracic Society criteria in the same way and by the same fieldworkers as had conducted the Burden of Obstructive Lung Disease (BOLD) multicentre study in Iceland. 17 18 The spirometry was conducted by trained and certified personnel, and the medical examination was conducted by doctors, all from the Landspitali University Hospital.

Briefly, testing was conducted with the participant in a sitting position wearing a nose clip and a disposable mouthpiece using the NDD Easy One spirometer (NDD Medizintechnik, Zurich, Switzerland). Prebronchodilator and postbronchodilator tests were carried out, with separate measurements performed before and ≥15 min after two puffs of salbutamol (200 μg). The primary reference equations used are derived from the third United States National Health and Nutrition Examination Survey (NHANES III) for adult Caucasians. 19

The criteria for chronic obstructive pulmonary disease (COPD) are defined by the Global Initiative of Chronic Obstructive Lung Disease. 17 COPD GOLD stage I was defined as FEV 1 /FVC ratio <0.7 after bronchodilation and GOLD stage II as FEV 1 /FVC ratio <0.7 and FEV 1 ≤80% predicted after bronchodilation. Reversibility of airway obstruction was calculated as a change in FEV 1 and expressed as a change in percentage (∆%).

For analysis of the spirometry results in those older than 40 years, a subset of the BOLD cohort 18 was used as a control group, with three age- and gender-matched controls from the BOLD (random general) population for each participant exposed to volcanic ash.

Questionnaires

Participants older than 18 years were asked to fill out questionnaires with questions about physical health, mental health, exposure to volcanic ash, experience of earthquakes, rumbling and smell from the volcano, and use of protective face masks and glasses. If necessary, the questionnaires were read to them by researchers.

Respiratory health before the eruption was assessed by the European Community Respiratory Health Survey (ECRHS) II Questionnaire. 20 From the main ECRSH Questionnaire, we used questions about wheeze, cough and phlegm prevalence, history of respiratory- and heart disease (questions number 1–3, 6–10 and 14, and question 7 from the screening questionnaire).

The participants were also asked if they had experienced other respiratory or eye symptoms, muscular pain, fatigue, nausea, headache, stomach pain or insomnia before and/or after the eruption started. If the symptoms had started after the eruption, they were asked to quantify how much these symptoms affected their daily life on a 3-point scale (rather little, rather much and very much).

Parents answered seven questions about respiratory symptoms, headache, stomach ache, insomnia, anxiety, depression and behavioural changes in children younger than 18 years. If these symptoms had started after the eruption, they were asked to quantify them on a three-level scale.

There were also questions about medical emergencies, use of medication, injuries, and accidents related to the eruption.

Mental health was assessed with three different psychometric scales, which all had previously been translated into Icelandic and used in other studies. When measuring psychological morbidity in relationship with the eruption, we used the General Health Questionnaire (GHQ-12), 21 22 the Depression Anxiety Stress Scale (DASS), 23 and the Post-Traumatic Stress Disorder (PTSD) Symptom Scale, Self-Report version (PSS-SR). 24 25 Each questionnaire was evaluated, and, if inadequately answered, excluded.

For GHQ-12, a score of more than 2 was considered indicative of experiencing more mental distress than usual (Bimodal score). 21

For PSS-SR, a score of more than 14 considered indicative of likelihood of PTSD symptoms in the participants. 24 25

For DASS, a score was given for each of the three dimensions addressed in the questionnaire. A score of more than 10 for depression, 8 for anxiety, and 15 for stress indicated symptom severity, from mild to extreme, as defined by Lovibond and Lovibond. 23 DASS and PSS-SR questionnaires were not administered on the first day of the study, but participants were given the option of filling out the questionnaires and mailing them.

Participants were asked how they had experienced ash fall, heard or been awakened by noise from the volcano, felt earthquakes, smell or limited vision outside due to ash fall at their homes; how many days they had to stay inside because of ash fall; how many hours they usually worked outdoors and if they had used protective equipment. Finally, participants were asked if they had received help or services from a number of organisations and institutions, and if they were satisfied with it.

Smoking history was investigated by asking participants if they had ever smoked, and if they were current smokers. Based on this information, the participants were classified into never-smoker, former smoker and current smoker.

Statistical analysis

All data were entered into a database by one observer. The analysis was mainly descriptive, and the primary outcome measure was prevalence in percentage (%) of the total number of answers in the given category. In comparisons between groups, we used Student t test and χ 2 test. Individuals with incomplete data were not excluded from the study, but non-replies to any single questions were excluded from individual analyses. We used SPSS software V.18 26 and R. 27

Altogether 207 out of 223 individuals (93%) who lived in the study area at the time of the eruption participated in the study. Local health workers, who recruited the participants, reported that inhabitants of two of about 80 farms had refused to participate, and 14 individuals who had initially signed up did not participate.

The most common reason for non-participation reported to the recruiters was either ‘being busy’, ‘not having any health problems’ or ‘old age’ (reported by relatives). Of the 207 participating residents, 40 were younger than 18 years. Most of them, 202 (98%) were medically examined, 164 adults and 38 children. The same proportion was tested with spirometry, and 156 adults were tested both before and after bronchodilation. All adults received questionnaires about symptoms and general health (GHQ-12). PSS-SR and DASS were administered to 150 people. Main demographic characteristics, symptom, and smoking rates reported by adults are shown in table 1 . The survey included 40 children younger than 18 years, of which 21 (53%) were girls.

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Demographic characteristics and questionnaire-reported symptoms of participants who all lived close to the Eyjafjallajökull volcano (n=167)

The age distribution of all participants is given in figure 2 .

Age distribution of the study participants (n=207) from the Eyjafjallajökull area investigated from 31 May to 11 June 2010.

Physical examination

The physician's judgement was that 126 (62%) of the participants were healthy. In the physician interview, 26 (13%) of adults reported history of asthma or other chronic respiratory diseases, 32 (16%) reported symptoms and signs other than respiratory and 27 (13%) participants indicated a history of mental symptoms. Asthma rates reported to physicians were similar to those reported in questionnaires. Of those with a history of asthma or other respiratory diseases, 38% had a normal spirometric test, but 39% reported worsening of the disease when exposed to ash ( table 1 ). Some reported to physicians that upper respiratory symptoms subsided when avoiding exposure by staying inside, wearing dust masks, and also that falling ‘fresh’ ash was more bothersome than ‘older’ ash re-suspended by wind. Farming was reported as the main occupation (63%) of adult participants.

Among the 202 participants who underwent spirometry, 37 (18%) were found to have impaired respiratory function by the examining physician.

Participants aged 40 years or older had on average a higher FEV 1 than the reference group (p=0.003), and they also showed less airflow reversibility (p<0.0001). The rates of chronic cough and phlegm were similar in the study participants and the reference group (8%–10%). Smoking was more common in the reference group than the volcano-exposed participants (p<0.01). After bronchodilation, 20% of those aged 40 years or older fulfilled the criteria for COPD stage I or higher, which was identical to that found among the general population reference group ( table 2 ). 18

Spirometry results, smoking status, reported chronic respiratory diseases and symptoms among participants aged >40 years compared to an age- and gender-matched reference group from the general population

The 35 children who were tested with spirometry had a normal per cent of predicted FEV 1 (102%±19%; mean, one SD) and FVC (104%±17%). Altogether four had FEV 1 % predicted lower than 85%; two of these had pre-existing asthma and revealed symptoms when examined (FEV 1 48% and 76%, respectively), the other two were previously healthy, but both had symptoms of upper airway virus infection (FEV 1 71% and 81%, respectively) when examined.

Almost half of the adult participants (43%) experienced symptoms from the upper airways and eyes during the ash fall. Almost everybody or 153 of 161 (96%) found facial mask and glasses protective against respiratory and eye symptoms when staying outdoor during ash fall. All participants of the study were exposed to ash fall at their homes, and almost all (88%) had to stay inside at least 1 day and one third (34%) for 6 days or more, which may explain some of the mental distress and child behavioural problems. Also, avoiding exposure by staying in the well-isolated houses may have kept symptom rates down. Almost everyone (98%) had heard the explosions from the mountain at their home, and 53% had woken up at night because of noise, but there was no obvious geographical pattern to this. The most common self-reported symptoms in adult participants are shown in table 1 . Men and women had similar rates of symptoms, except that women tended to report more throat and upper airway irritation (p=0.06, Student t test).

Women reported more frequently mental health deterioration than men, according to the GHQ and DASS, and the highest rates were found in those between 35 and 49 years of age ( table 3 ). Symptoms of post-traumatic stress syndrome (PSS-SR) were found in 7% of participants and were more common among women than men and in those slightly older (50–64 years old). Very little effect on mental health was reported in the age group 18–34 years.

Mental symptoms following the eruption of Eyjafjallajökull

Table 4 shows the proportions of participants experiencing mental distress by level of exposure (experience of the volcanic eruption). Experiencing a feeling of helplessness or fear for the lives of others or oneself during the eruption period was associated with higher rates of likely PTSD symptoms. The frequency of mental distress (as measured by the GHQ) was significantly (p<0.05) higher in those who had been awakened by noise.

Mental symptoms and experiences during the eruption of Eyjafjallajökull

Symptoms of depression and anxiety (DASS) were more common among those who had experienced earthquakes and had thought that their lives were in danger ( table 4 ).

Many children of school age were not in the area during the heaviest ash fall. A boarding school outside the affected region invited the Eyjafjallajökull children to stay for some weeks. By the time the health survey was carried out, most were in the area. Nevertheless, 13 (28%) of parents reported in the questionnaires that their child had experienced throat or upper airway irritation symptoms (data not shown). Eight (13%) reported headaches, while three parents (7%) reported that their child or children had had nausea or stomach pain during the eruption. Of the 40 participating children, five had a history of asthma and they all reported in the medical interview that they had had more symptoms during the ash fall and needed more antiasthmatic medication than usual. Regarding mental distress, 39% of participants with children reported increased worries or anxiety in their children, 18% reported increased behaviour problems and 16% reported sleep-related problems.

In a well-defined rural population that had been exposed to volcanic ash particles with a substantial inhalable fraction for several weeks during the Eyjafjallajökull eruption, we found only a small degree of physical health impairments soon after the eruption. No hospital admissions, fatalities or life-threatening or serious symptoms or diseases that could be attributed to the eruption were found in this study cohort. From the answers to the questionnaires, we could conclude that compared to the general population sample from the BOLD study, the study participants reported a similar prevalence of respiratory symptoms and obstructive lung disease. Some symptoms of mental distress were found in this study.

In our study, we contacted the whole population living closest to the volcano and had a high participation rate (93%). According to the recruiters, some non-participators reported not having any health problems, so the symptom rates presented here may be overestimated. There may also be a recall bias, so that those who are worried about their health are more likely to participate and recall symptoms. On the other hand, some vulnerable individuals may have chosen not to participate or had left the most affected area, which may cause us to underestimate the symptom rates.

To facilitate comparisons with other studies, we used standardised methods in both the medical examinations and questionnaires, as well as the spirometry in this survey. However, the population is small (N=207, of which 167 were adults) and due to stressful circumstances during the test period, not all participants completed the questionnaire, which limited the statistical power of our analyses.

The participants from the Eyjafjallajökull area had better lung function than the general population sample, most likely due to a much lower prevalence of smoking. They also had less obstructed airways when tested again after use of a bronchodilator, probably because those with asthma had already increased their bronchodilator treatment during the ash fall. Also, the general population reference sample lived in urban and suburban areas, whereas the Eyjafjallajökull area is predominantly rural. The children had normal spirometry measurements. Previous studies have not found changes in lung function in children after volcanic ash exposure, but asthma hospitalisation rates have been seen to increase after several eruptions, 11 12 and a dose–response has also been found in a Japanese study of asthmatic adults who were exposed to volcanic ash. 28

Intermittent symptoms in the eyes and upper respiratory organs were very common, but they could be prevented by wearing eye protection and face masks, or avoiding exposure by staying inside. Facial masks and glasses for eye protection were made widely and freely available by the public health authorities. These protective equipment were in plentiful supplies purchased for the swine flu epidemic the previous year. Icelandic houses are generally quite well insulated with windows that shut tightly and seemed to offer some protection.

It was recorded in several of the medical examination reports that people found the ash more irritating in the beginning of the eruption, perhaps because fresh ash particles can have chemical compounds on the surface, which are later washed away. 2 3

In a study of the ash from Eyjafjallajökull, Horwell et al 2 found most samples to have little potential for damaging health. The ash contained a negligible amount of crystalline silica, and though one sample showed some cytotoxicity in in vitro studies, the report concluded that the ash was unlikely to have an effect at the levels to which people were actually exposed.

The first results from a study of lung tissue samples and samples from the gastrointestinal tract of animals brought to slaughter from the affected area in the autumn of 2010 did not reveal any significant pathology. 29

During the first days of the eruption, precautions for individuals with respiratory disease were issued throughout much of Europe, both by national health authorities but also by the WHO. 30 Symptom surveillance studies, however, have shown a slight increase in the number of individuals on the European continent seeking medical help for certain symptoms in the period when the region was affected by ash. 31 32

In our study, 39% of participants reported some symptoms of mental distress, as measured by the GHQ. A high GHQ score was associated with feeling helpless or afraid or being awakened by noises from the volcano. The rate of GHQ cases in this study was more than twice as many as in a 2004 study of Icelandic farmers where 17% scored above the reference value for mental distress in the GHQ. 33 However, in a Japanese study of a population exposed to a volcanic eruption, 66% were found to suffer from mental distress, but this population had been evacuated and were unable to return to their home region for years. 14 Only half of the participants in this study population were evacuated, and then only for a few days.

The proportion of participants who exhibited symptoms of post-traumatic stress (7%) was similar to that found following a large earthquake in the south of Iceland in 2008. 34 When the eruption was still active, there were substantial disturbances in people's daily routine. Some of the fatigue and stress indicated by the high prevalence of mental distress may be attributed to the increased workload during the eruption and at the same time the uncertainty about one's own health, the health of others, the livestock and the future. In addition, our results showed that increased mental distress might partly be explained by the extent of experience of volcanic phenomena, as it was associated with having experienced earthquakes related to the eruption or experiencing threat to one's own life or that of others. On the other hand, those who are distressed may experience these phenomena more strongly during an eruption. Information about the possible health effects of the ash was needed for the affected individuals. Therefore, early in the eruption, collaboration was established with national as well as international experts from the WHO and EU, and the International Volcanic Health Hazards Network, whose pamphlets were translated into Icelandic and distributed widely. 35 Trauma response teams on behalf of the Red Cross were present in the evacuation and community centres, and a number of community meetings were held to inform the affected population.

Conclusions

During the time when volcanic ash was falling from the Eyjafjallajökull eruption, the majority of participants experienced symptoms from eyes and upper airways. Those with underlying obstructive lung disease were particularly vulnerable; half of the asthmatic adults and all the asthmatic children had more pronounced symptoms during the eruption.

Our results indicate that public health measures were effective in relieving symptoms. Recommendation to avoid exposure by either staying inside or wearing dust protection masks and glasses when outdoors during the ash fall or storms may have contributed to mitigation of irritation and symptoms.

During a volcanic ash fall, intensive medical attention should be aimed at vulnerable individuals with underlying respiratory diseases and known mental disorders.

Little is known about long-term health effects of exposure to volcanic ash, but continuous surveillance and research is necessary as the ash is likely to remain in the environment for some years to come. A follow-up study would be helpful in interpreting the spirometry results, but no severe health outcomes could be associated with the eruption in this study.

Acknowledgments

We thank Olof Arnadottir and Helga Thorbergsdottir, RN, South Iceland Primary Health Care Centre; Berglind Gudmundsdottir, psychologist, Landspitali-University Hospital; Edda Bjork Thordardottir, PhD student, University of Iceland; Gudrun Pétursdottir, PhD, University of Iceland Centre for Sustainability Studies; Kristinn Tomasson, MD, Administration of Occupational Safety and Health in Iceland; Urdur Njardvik, lector in psychology, University of Iceland; Ossur Ingi Emilsson, Cand. Med., University of Iceland; Halldora Brynjolfsdottir, Hildur Ragnarsdottir, Kristin Bara Jorundsdottir and Sigrun Gudmundsdottir, research specialists, Landspitali-University Hospital; Elísabet Magnusdottir, research assistant, University of Iceland and Agust Gunnar Gylfason, project manager in risk management, Icelandic civil protection service for their assistance in conducting this study.

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To cite: Carlsen HK, Gislason T, Benediktsdottir B, et al . A survey of early health effects of the Eyjafjallajökull 2010 eruption in Iceland: a population-based study. BMJ Open 2012; 2 :e000343. doi: 10.1136/bmjopen-2011-000343

Contributors All authors were involved in designing the study, interpreting the results and drafting the article. TG and BB conducted the medical examinations, HKC and AH implemented the questionnaires, TBK recruited the participants, TT analysed the data on the ash and ash fall and HB initiated this study and collected all data.

Funding Funded by the Ministry of Welfare. The Health Authorities.

Competing interests None.

Patient consent Obtained.

Ethics approval Icelandic Health Authorities. According to Icelandic legislation (Act no. 19/1997 on Health Security and Communicable Diseases), incidents concerning public health threats are to be investigated without delay such as urgent outbreak investigations. Ethics approval may take some time and could not possibly be obtained before this investigation started.

Provenance and peer review Commissioned according to the Act on Health Security and Communicable Disease Control No. 19/1997. Externally peer reviewed.

Data sharing statement The authors are willing to share all available data. There are additional unpublished data on spirometric measurements available if requested.

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