| Bangladesh
 A year after Cyclone Aila, UN assessment finds health services need further scaling up
 One year after Cyclone Aila made landfall in Bangladesh,
UN agencies, including WHO, UNDP, UNICEF, WFP, FAO, IOM and UNFPA, jointly
conducted an assessment of the affected areas, on 9-12 May 2010. The areas
covered were Shyamnagar and Assasuni upazila in Satkhira district and Koyra
and Dacope upazila in Khulna
district.
The objective of the assessment was to analyse
the latest developments, current gaps and future needs, and to validate
secondary and baseline information, based on wide consultation.
Findings:
The UN Assessment Team found that the
structures of health centres had deteriorated as insufficient reconstruction
work has been carried out.
The first assessment following the cyclone,
last year, had showed minor damage in the health sector and no significant
outbreak of disease, although there was very limited support for
rehabilitation of affected people. But the overall situation in the worst
-ffected areas has declined.
The recent assessment revealed that health
facilities are severely understaffed and are barely able to provide even the
most basic health care services. Those living on the embankments were found
to be suffering from a range of diseases like diarrhoea, skin infection, and
pneumonia. There is micronutrient deficiency and malnutrition as cultivable
land remains inundated by saline water, so crops and vegetables are not
growing.
Since the catchment area for upazila health
complexes are very small, and the communities are far away, in addition to
the non-availability of adequate health care at these health facilities,
affected people are not able to visit health complexes, union health centres
and community clinics. So the people are compelled to receive treatment from
their nearby village doctors (indigenous medical practitioners). The village
doctors and birth attendants were found to have insufficient or, in some
case, no training and were unaware of basic treatment protocols for common
ailments.
There were reports of psychosocial and mental
illnesses. However these remain untreated as no psychosocial support
activities are being provided.
Democratic People’s Republic of Korea (DPRK)
Workshop to prepare for floods and other
emergencies
In May 2010, a three-day simulation workshop
for emergency preparedness in DPRK was held in view of possible floods in the
summer of 2010.
This was facilitated by the UN OCHA Office in Bangkok, and
international organizations and iNGOs in DPRK participated. WHO -DPRK
participated in this workshop as part of the health and nutrition cluster.
The workshop
 identified the actual gaps and needs of the
emergency preparedness and response,
highlighted the
capacity of the international community in assisting the DPRK Government in
emergency preparedness and response.
established the
inter-organizational and inter-cluster (health & nutrition cluster, food
cluster, water & sanitation cluster, education cluster) collaborative
network for emergency preparedness.
provided training to
the international community in DPRK in developing the flash appeals in case
of emergencies.
UN international team reviews CERF-funded
projects
In May 2010, a UN Central Emergency Response
Fund (CERF)Evaluation Mission from UN OCHA offices
in Geneva and New York visited DPRK to review the impact
of the previous and current CERF projects in the country and to assess
further needs.
The mission visited the areas covered by
CERF-funded projects in the northern and other parts of the country that
focus on health, nutrition, water & sanitation, food distribution and
other sectors, and are implemented by the various UN organizations. Their
visit included WHO-supported projects in the north Hamgyong Province, such as training on maternal and child
health and rehabilitation of pediatric and maternity hospitals (Operation
Theatre, Emergency Unit, Intensive Care Units), district-level hospitals and
Ri-level hospitals.
The mission reviewed the life-saving impact of
the projects in comparison with the non-project/pre-project settings and
expressed satisfaction that the programme was successfully implemented.
The mission acknowledged further
humanitarian needs in the health sector and agreed to continue support
from the CERF for DPRK. Expansion of projects to include improving water
supply for key life-saving units along with portable solar batteries for
warming the water for maternity and neonatal units was also advised.
Dissemination
of the ‘Kathmandu Declaration on Protecting
Health Facilities from Disasters’
The ‘Kathmandu Declaration on Protecting
Health Facilities from Disasters’, adopted in the 27th Health Ministers’
Meeting, was translated and distributed to the national and international
counterparts at health and nutrition coordination meetings in DPRK.
Procurement
for emergencies
Procurement of rehabilitation supplies and the
relevant kits for two county hospitals (operation theatre, delivery room,
laboratory, emergency room, blood section) under CERF is in process.
Indonesia
Earthquake
in Aceh
On 9 May 2010, 12:59 pm local time, an
earthquake registering 7.2 on the Richter Scale
struck 66 kilometers southwest of Meulaboh on the Aceh coast. This area had
been devastated by the 2004 earthquake and tsunami.
A local tsunami alert was issued and then
called off at 2:30 p.m. local time, with a 50-cm tsunami reported in Banda
Aceh, the capital of Aceh.
The WHO Field Office in Banda Aceh reported
that local residents felt a moderate shake for 3 minutes with several
aftershocks, sparking panic. Many people rushed from their houses and some
sought higher ground.
However, there were no deaths and nine people
were injured according to the Crisis Centre, Ministry of Health. One Community Health Center
and three houses were damaged.
Electricity power and communication lines were
disrupted in Simeuleu, Aceh
Province.
The Ministry of Health (MOH), and others, in
close collaboration with WHO Indonesia and Banda Aceh Field Office, sent
health teams and provided Integrated Emergency Health Services according to
Standard Operating Procedures.
Training of Trainers (TOT) for the ‘100 Days Hospital
Disaster Plan’
WHO and the Crisis Center, MoH, conducted a
Facilitators’ Training for Health Human Resources Strengthening in 100
Hospitals based in disaster-prone areas of five Regions in Eastern
Indonesia. It was held on
8 – 12 May 2010 in Surabaya.
The training was attended by 41 participants
from East Java, South Sulawesi, South Kalimantan, Bali, North Sulawesi, and Sidoarjo District Hospital.
The outcomes of discussions during this
training are:
Hospitals Disaster Plan (HDP) can be different
for every hospital and can be modified based on the local situation.
The Hospital Disaster Risk Reduction Plan
serves as apart of SOPs for disasters, and describes how a hospital can be
activated to an emergency phase during a disaster, by involving all
units.
Universities have an important role in
disaster response since they have the capacities to make Hospital Disaster
Plan more structured.
A policy/commitment is needed from
stakeholders to develop HDP.
Media management and communication plans are
important for dealing with the media when situation is chaotic due to a
disaster.
Once the training modules are finalized, there
will be sentinel hospitals to serve as models for other hospitals to visit,
learn and share experiences.
Training materials have been posted in the training website for references (www.kesehatan-bencana.net).
Early
Warning and Response System (EWARS) Strengthening and Evaluation
WHO has assisted the Matra unit of MoH in conducting Early Warning and Response System (EWARS) Strengthening
workshops in three different provinces to cover all disaster prone areas in Indonesia.
The first EWARS strengthening workshop was conducted in Padang,
10-12 May 2010, followed by one in Yogyakarta,
on 17-19 May 2010 and the third in Makasar, on 25-27 May 2010.
During the Padang workshop, the district health
offices of the 2009 earthquake-affected areas presented the surveillance and
other activities in response to the earthquake. Other subjects covered
include flood management in West
Java Province,
Data and Information Management in Emergencies, EWARS according to WHO standard, Information & Communication in Emergencies,
Immunization in Post –Disaster Situation, Disease Control, Rapid Health
Assessment, Risk Management, Vector Borne Disease Control in Emergencies,
Water & Sanitation in Emergencies and Surveillance Epidemiology &
Early Warning System in Emergency.
Thirty health staff attended the Yogyakarta workshop.
The third EWARS strengthening training was
conducted in three days and had 40 participants. The following roles were
suggested for WHO: (1) to support MOH
in developing EWARS for Emergency and Disaster; (2) to facilitate Matra unit
of MoH on the development of an operations room; (3) to assist MOH in the
development of EWARS special forms for emergency and disasters; and (4) to
support MOH in conducting trainings to strengthen EWARS at the district
level.
Revision
of ‘Technical Guidelines for Health Responses to Disasters’
The Crisis Center of the Ministry of Health
invited WHO to assist with a meeting on the revision of the ‘Technical
Guidelines on Health Crisis Responses to Disaster’, on 25-27 May 2010 in Bandung.
The aim was to facilitate the revision of the
‘Technical Guidelines of Health Crisis Management’. The objectives were to
ensure the following (1) the guideline is revised according to the recent
policy, law and regulation of each related units; (2) the guideline is
revised based on the updated version of SOP from related unit; (3) role of
health facilities will be reflected clearly in the guideline; and (4) other
inputs will be incorporated in the guideline.
India
Launch
of Global Campaign on ‘Making Cities Resilient’
On 8-9 June 2010, The National Institute of
Disaster Management (NIDM), in collaboration with Ministry of Urban
Development, Government of India and United Nations International Strategy
for Disaster Reduction, Geneva
held an International Workshop on ‘Making Cities Resilient’
.
This workshop is a prelude to organizing the
launch of the ‘Global Campaign on Making Cities Resilient – My City Getting Ready’ .
Among the participants in the workshop were
mayors of different cities in India
and representatives from cities of South Asian countries such as Pakistan, Bangladesh,
Nepal, Sri Lanka, Bhutan,
Afghanistan and Maldives.
They discussed the various dimensions of emerging
urban risks and pledged their commitment to make their cities resilient to
disasters.
Earthquake
near Nicobar Islands
A strong earthquake with a magnitude of 7.5
occurred on 13 June 2010 at 00:56:47 (IST), with the epicentre located 150 km
west of Mohean, Nicobar Islands, in India. The depth of the epicenter
was 35 km.
People ran from their houses in Port Blair,
capital of the Andaman and Nicobar Islands,
immediately after the earthquake struck, officials and witnesses said. There
were no initial reports of casualties or damage.
According to Chennai Meteorological office,
the tremor was also felt in several parts of Chennai.
The Pacific
Tsunami Warning
Center in Hawaii
had issued a regional tsunami watch for all areas of the Indian Ocean,
including India, Indonesia, Sri
Lanka, Myanmar,
Thailand and Malaysia,
which was later withdrawn.
The Hyderabad-based Indian National Centre for
Ocean Information Services (INCOIS) also issued a 'Tsunami Watch' notice soon
after the earthquake, but later it was withdrawn.
125 000 displaced in cyclonic storm in Assam
Cyclonic storms which are locally called
‘Bordoichilla’ struck Assam
on 14 and 24 April 2010. Both occurred late at night.
The
storm on 24 April lasted for about 45 minutes and was accompanied by heavy
rains with wind speed of 80 km per hours.
Twenty six persons were killed and many more
injured due to this storm. An estimated 125 000 people were displaced in the
worst-hit Lakhimpur district alone.
Myanmar
Floods in North Rakhine
State
The Northern
Rakhine State
faced severe floods due to continuous rain since mid-June 2010. Maungdaw and
Buthidaung were worst affected.
The floods and landslides claimed 63 lives as
of 23 June 2010, according to state media.
In Buthidaung, the township hospital was
flooded, but became operational again on 18 June.
Doctors from the state level and other
townships have been dispatched to Maungdaw and Buthidaung.
A WHO national consultant (EPI) is now in the Rakhine State to provide support to the
Ministry of Health in assessing the situation. In addition, WHO has national consultant
stationed in Sittwe and is providing necessary assistance.
Disaster kits (stocks from Rakhine State
Health Office), drinking water, anti-snake venom, bleaching power, oral
rehydration solutions, antibiotics and other supplies were provided by MOH
and other partners.
The Myanmar Medical Association (MMA), with
support from UNFPA, and based in Rathedaung
Township has also
offered mobile services for the affected population in Buthidaung.
Nepal
Health Cluster Plan
The Emergency Health and Nutrition Working
Group (EHNWG) discussed and circulated the health sector plan for a major
earthquake scenario for the Kathmandu
valley.
A sub-group (working committee) has been
formed to work on EHNWG contingency plan.
The working committee includes representatives from UNICEF, UNFPA, UN
OCHA, Merlin, Handicap International, CARE, and is coordinated by WHO.
Status of Contingency Planning
Contingency Planning training has been
completed in 17 districts.
The training is planned for five additional
districts in 2010.
Preventing diarrhoeal outbreaks
WHO will support a regional programme on
disaster/outbreak management orientation and contingency planning training of
trainers, in the Mid- and Far- Western Region of
Nepal.
The programme is scheduled for 14-15 June 2010
in Nepalgunj for the Mid-Western districts and 17-18 June 2010 in Dadeldhura
for the Far-Western districts. There
will be 30 participants from the region covering District Public/Health
Officers, Rapid Response Teams (RRT) focal point, hospital directors from the
districts. WHO’s
Communicable Disease Surveillance and Response (CSR) and Emergency and
Humanitarian Action (EHA) units are providing technical inputs to the
training programme.
Health Management Information System (HMIS)
EHA continues its collaboration with HMIS unit
of the Ministry of Health and Population (MoHP) to conduct health facility
mapping survey.
The surveys have been finalised and the health
facilities in all 27 districts are now fully mapped using GIS application.
EHA also bought additional data layers of meteorological
data to analyse the fluctuation in rainfall over 40 years and its impact on
the disaster-prone districts of Nepal.
At the
end of July there will be workshop to disseminate the survey findings to the
wider communities in Nepal.
Sri Lanka
Humanitarian
Situation in the North: Menik Farm
As
of 17 June, less than 50 000 IDPs remain in the five remaining zones (zones
0,1,2,3 and 4) of Menik Farm.
Three
referral hospitals with three primary health care centers now cater to these
IDPs, with the primary health care center in zone 0 also acting as a referral
hospital. The former MSF hospital located in Cheddikulum Coordination Centre
continues to serve as the referral hospital for all the zones, operating on a
24-hour basis. Zone 6A was closed this month.
Medical
staff, including doctors and nurses, has now been moved to resettlement areas
as the number of IDPs have decreased in Menik Farm.
The
last coordination meeting of health partners for Menik Farm took place on 8
June 2010, and was chaired by the Director, IDP health care. The biggest
concern is that the transportation needs of doctors and nurses and even
emergency ambulance services provided by UNICEF and IOM respectively will end
by July and August. This is likely to severely affect emergency services for the remaining
IDPs.
Severe
winds and rains have damaged the roof and dome of the referral hospital in
zone 2. WHO has began to assist the Sri Lankan Ministry of Health (MOH) in
making urgent repairs.
Eight
Public Health Inspectors (PHIs), supported by WHO, continue to work in Menik
Farm, conducting disease surveillance and working on water quality testing
and maintaining the environment to sanitation standards.
Health
in the resettlement areas
IDPs from Menik Farm continue to resettle in
their areas of origin, with Jaffna
and Kilinochchi districts receiving the highest numbers of returnees.
Coordination meetings amongst health partners
in Mannar and Vavuniya took place this week, and were chaired by the
respective Regional Director of Health Services (RDHS). Mannar RDHS has
requested expansion of the areas being covered by the current mobile medical
services by health partners (such as MSF F, CHA, PSL and IOM), as there are
communities in the district that are located far away from the main health facilities
of Mannar.
The main challenge continues to be the
provision of primary health care facilities to the resettlement population
and the lack of medical staff. The health assistants recruited by the MOH and
supported by WHO have begun to work in the health facilities of Mannar,
Kilinochchi and Mullaitivu to supplement the work of doctors and the nurses
currently in the resettlement areas.
The rehabilitation of Dharmapuram hospital in
Kilinochchi district will be supported by WHO. It
had been identified by the RDHS and MOH as a key health facility to be
rehabilitated in the resettlement area.
Through UNICEF and UNFPA support, the
operating theatre in Kilinochchi
District General
Hospital is now able to
conduct emergency obstetric care to pregnant mothers. WHO will be providing
other essential medical equipment needed in Kilinochchi, Mullaitivu and
Mannar District hospitals.
Humanitarian
situation in the North: Communicable Diseases
The outbreak of mumps during the second week
of April in Menik Farm has begun to subside. During the previous week only
nine suspected cases have been reported, compared to the peak of 29 suspected
cases that had been reported in the beginning of May.
There has not been a report of increase in the
number of other communicable diseases during the current rainy weather
conditions in Menik Farm. No reports have been received on any outbreak of
diseases in the resettlement areas.
WHO will continue to support eight PHIs in
Menik Farm to ensure that any suspected cases of communicable diseases in the
camps are immediately followed up. The rotation of
PHIs in the resettlement areas from Menik Farm continued, to supplement the
disease surveillance system in the Vanni.
The RDHS of Kilinochchi has recruited an
additional PHI to work in the district, which will be supported by WHO.
Mullaitivu RDHS has plans to recruit new PHIs as well.
WHO will support the RDHS in Jaffna to establish a water testing
laboratory to assist in the control of water borne diseases activities.
Health
Cluster Coordination
Health cluster coordination meetings continue
to in Colombo
and in the different districts of the Vanni. Meetings in Vavuniya and Mannar
for example tackle issues on health services to the resettled population,
whilst the monthly meeting in Menik Farm specifically discusses issues on the
IDPs. RHDS chairs these meetings in the districts with WHO
as co-chair and supports secretarial services, whilst the Director of IDP
Healthcare chairs the Menik Farm meetings with WHO as co-chair. The number of
participants in general has decreased as many of the health partners have
completed their support for the humanitarian crisis, such as Mercy Malaysia
and AmeriCares.
A meeting of all health partners has been
organized by the Governor of the Northern
Province to take place on the 22 June in
Trincomalee, to provide a platform for all stakeholders to share their
activities, experiences and plans for the Menik Farm and the resettlement
areas until the end of the year.
WHO
Response to Floods
Heavy pre-monsoon rains and thunderstorms on
14 May 2010 resulted in flash floods, rising levels of water, strong winds
and landslides. Thirteen out of the 25 districts in Sri Lanka were affected, with Colombo,
Gampaha, Kalutara, Ratnapura, Kegalle and Galle districts suffering the worst floods.
On 22 May 2010, 606 072 people were reported to have been affected in total.
WHO conducted an assessment with the MOH on 20
May in Gampaha district where 194 700 people had been affected.
The priorities identified by the MOH were prevention
of any outbreak of water borne diseases and provision of medical mobile teams
to the displaced population, who were temporary accommodated in schools and
welfare centers.
WHO’s assistance to the MOH included
The provision of 60 000 chlorine tablets for
water purification.
US$15,000 to support the surge capacity of the
MOH in the most affected 6 districts.
Technical support to the MOH in the control of
preventable diseases.
Timor-Leste
Landslides in Quelicai sub-district (Baucau
district)
Heavy rainfall on 6 May 2010 led to
landslides, two kilometres wide , near the villages
of of Lakulio and Letemuno in Quelecai sub district, Baucau district.
An assessment team consisting of national and
local humanitarian officers visited the disaster-affected areas and
identified 80 families that suffered most.
Fifty five houses were damaged, of which 38
houses suffered major damage, and 16 houses had minor problems.
The landslide also damaged several acres of
land including rice fields.
The Ministry of Social Solidarity (MSS)
provided humanitarian assistance including: distribution of Food Items and
Non-Food Items such as. rice, fried noodles, cooking
oil and canned food, hygiene kits, tarpaulin, coats, mats, gloves and
household appliance.
The affected people were temporarily evacuated
to a safe place away from disaster. MSS distributed construction material
including cash assistance to the families.
Health services were provided through the
Health Centre and SISCA programme.
Landslide in Hatubuilico sub-district
(Ainaro District)
Landslides and floods also occurred on 21 - 22
May 2010 in within five kilometres of Mulo village in Hatubuilico
sub-district, Ainaro district. As many as 143 families were affected.
The assessment team identified 30 houses
completely destroyed, with additional damage to three public facilities, a
primary school, a church and a community health centre (CHC).
Humanitarian assistance was coordinated by the
Ministry of Social Solidarity. Food
and non-food items including construction materials were distribuited to the
victims.
Although a CHC was affected, health services
did not get interrupted.
Regional office for South-East Asia
(SEARO)
Logistics Support to countries
Inter-agency emergency health kits have been
sent to Nepal
and DPRK, so that they are in place before the monsoons/rainy season and
possible consequent floods.
SEARO now has two logistics hubs, In Delhi and
Bangkok.
Scaling up logistics systems of the EHA unit
is a priority this biennium.
SEARHEF
funds to Bangladesh
After a fire in Dhaka
killed more than 100 people, the Government of Bangladesh requested funds
from the South-East Asia Regional Health Emergency Fund (SEARHEF) to support
a Burns and Trauma centre.
An amount of $175 000 has been released from
SEARO and part of it was used to procure essential antibiotics and burn
dressings.
Nursing and Midwifery in Emergencies
Collaboration between the Nursing and EHA
units in SEARO is supporting documentation of case studies of the
contribution of nurses and midwives during emergencies and in disaster
preparedness.
The idea is to shed light on the role and
responsibilities of nurses and midwives during emergencies in the Region, as
well as the issues, challenges and constraints they face.
Gaps identified through these case studies,
will allow strengthening of those areas to improve the capacity of nursing
and midwifery services in disaster preparedness and in emergencies.
Primary Health care in Emergencies
An international conference on primary
healthcare in emergencies is being planned.
It will be held in Dhaka,
Bangladesh,
in September 2010.
The conference will look at the revitalization
of components of primary healthcare, such as people-centred care, universal
coverage and equity, and service delivery, in the context of different
emergencies.
It will also look at the way forward in SEAR
countries, using the SEARO Benchmarks for emergencies that are related to
communities.
Photoessay:
EHA at
work in SEAR
Will Health Facilities Function when
most needed?
The Emergency and Humanitarian Action programme of the South East
Asia Regional Office Of the World Health Organization produces regular news
update of events and activities of countries of the Region. This note, which
is not exhaustive, is designed for internal use and does not reflect any
official position of the WHO Secretariat.
For more information, please visit our website: http://www.searo.who.int/eha
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