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This is an assessment of health issues in the hardest hit countries in SEARO compiled by the Communicable
Diseases Department of WHO.
Report: 1
17 January 2005
Overview
Background
Triggered by 9.0 earthquake off the northwest tip of Indonesia,
a historically unprecedented tsunami was unleashed early Sunday morning, 26 December 2004. Walls of water
moving at high speed pounded coastal communities from Indonesia
to Kenya,
leaving (as on 16 January) 157,526 dead, 27,266 missing and two million
displaced.
Like the loss of life across WHO’s South-East Asia Region
(SEAR), the consequences to public health were uneven from location to
location. In the hard hit region of Aceh, Indonesia,
for example, more than half the public
health infrastructure (health facilities etc.) were lost. In other areas,
such as Sri Lanka,
the public health infrastructure remained largely intact.
Current assessment
At day 22, the epidemiological information system is still
evolving and, like the damage done by the tsunami itself, it varies from
country to country. Among the hardest hit areas, Sri
Lanka and Maldives
have a good epidemiology monitoring and reporting system in place. In Aceh,
on the other hand, the system is functioning at a 50% level but improving
quickly.
Millions are still living in overcrowded and unsanitary
conditions. Water and sanitation is inadequate in some areas and Diarrhoeal
diseases remain a high concern.
In Indonesia,
Sri Lanka, India
and Myanmar,
conditions have been created which increase mosquito breeding, heightening the risk of malaria and dengue.
Vector control measures are being implemented for malaria and dengue.
Mental health trauma remains a major concern across all
affected areas.
Most acute care needs are being addressed, although people
in areas such as Aceh remain at high risk of injury-related tetanus which
will require administration of tetanus toxoid.
Communicable diseases are under control presently but the
risk is very high and, in vulnerable populations (i.e. children, injured,
pregnant women and the elderly), potentially life threatening. Access to
medicines (such as oral rehydration salts for treating diarrhoea and
preventing dehydration, and antibiotics for management of pneumonia) remains
a priority. Immunization campaigns to prevent measles outbreaks must be
undertaken where coverage is low. All
these efforts require a comprehensive and coordinated approach for disease
prevention and control based on evidence generated through effective surveillance
and early-warning systems.
Outbreaks
No outbreaks of communicable diseases identified, although
many clusters of cases have been investigated. Health Picture
at a Glance
 Indonesia– Sporadic measles and malaria cases have been identified but these are not above normal range. Measles
vaccine campaigns have been conducted. Measures to control mosquitoes include
spraying (fogging) and the use of insecticide treated bed nets and plastic
sheeting.
 Health
assessments: This activity has increased with assessment teams being
flown into remote areas by military helicopters.
Surveillance: Daily reporting begins today through hospitals
(inpatients) and laboratories.
Laboratories:
One provincial public health lab is physically intact but one-third of
personnel lost during the tsunami. Assistance is being supplied by Malaysian,
Singaporean and Australian lab teams, but there is an urgent need for
supplies and media reagents to begin operations. Malaria tests will resume on
Tuesday with a capacity to examine 20 to 30 slides a day, Dengue tests will
resume on Thursday.
Malaria:
Sporadic cases being identified through EWARN (emergency surveillance and
early warning) system. Three cases of laboratory confirmed P falciparum at
one IDP camp; two are pre-tsunami treatment failures who have relapsed. A
third case has been identified, possibly local transmission. All are being
treated with quinine and are recovering. Twelve thousand rapid diagnostic
tests arrived today.
Cholera:
No cases. Rumours being reported. Many have been investigated and found to be
unsubstantiated. Preparations underway to prepare a cholera isolation
facility in Aceh’s provincial hospital.
Measles:
Two cases reported so far from Aceh. Large-scale immunization programs of
children between the ages of 9 months to 15 years have been conducted. Target
population: 1.16 million. (It takes ten days following immunization for
protection.)
Thailand:
Disease
surveillance reports are being provided daily.
No
significant outbreaks of GI and respiratory infections such as cholera,
measles, influenza or encephalitis detected. There are some sporadic
diarrhoeal cases among volunteers in one province
Dengue
cases reported but not above expected levels
India:
Measles
immunization campaign completed in affected Tamil Nadu districts (except
Purdokottai) with 75,338 children 6 to 59 months vaccinated.
Nothing above background levels of acute diarrhoeal syndrome , typhoid
and chickenpox reported in the affected districts of Kerala
Sri Lanka
Measles:
one case confirmed in a small camp and all 56 people in the camp have been
vaccinated.
Water supplies are sufficient but sanitation
problems continue.
Maldives:
Daily
reporting of 12 communicable diseases from all the atolls and regional
hospitals has started.
There
is a slight increase in the reported incidence of diarrhoea, ARI (acute
respiratory infection) and viral fever but this increase is still within the
normal range.
Public
health laboratories are being established to diagnose epidemic-prone diseases
and test water quality.
WHO’s public health
goals and actions
WHO support is being provided within the framework of a
strategic plan for the health response to the tsunami. This includes
emergency surveillance and early warning (EWARN) system for outbreak alert
and response, establishment of mobile laboratories, deployment of staff and
consultants to provide technical support at the ground level in communicable
diseases, psychosocial support, water and sanitation, and nutrition. GOARN
(the Global Outbreak Alert and Response Network) has been mobilized to assist
in outbreak detection, verification and management.
Initial support was provided immediately by WHO country
offices, reinforced by the WHO regional office for South-East Asia—SEARO.
In the emergency phase, the response was coordinated by WHO’s Health Action
in Crisis and SEARO’s Emergency and Humanitarian Action. Now WHO technical
support activities are largely provided by its Communicable Diseases
department in the South-East Asia Regional offices in New Delhi (and
reinforced by HQ in Geneva) as well as by all other WHO departments including
the Immunization and Vaccine Development, the Noncommunicable Diseases and
Mental Health, EHA, Health System Development, Family and Community Health
and by the department for Sustainable Development and Environment.
The public health challenges in the wake of the tsunami
change over time.
Emergency
phase:
Immediately after the disaster, injuries including the
resultant infections, and water
contamination were the most urgent health threats. Other needs included body
disposal and rapid health assessments to determine planning and resource allocation.
Anticipated health risks included respiratory infections, measles, and water
borne diseases such as diarrhoeal and dysentery (including cholera) resulting
from overcrowded conditions and poor sanitation. A system of monitoring and
evaluation on an ongoing basis was needed to help identify operational
difficulties, refine strategies and modify actions. Also required were
effective coordination of efforts among partners on the ground, streamlined
logistics management and transparent communication.
Other essential activities include identifying persons at
special risk such as pregnant women and children with diarrhoea and ensuring
that their health is protected. Also critical is establishing surveillance
networks to monitor, verify and respond to outbreaks especially in
concentrations of displaced persons whose health may already be fragile.
While these risks will continue because of the environmental conditions, such
as overcrowding still persist in many areas where people having to live in
makeshift settlements and camps, concerns are emerging with regard to
collection of stagnant water resulting in mosquito breeding creating a risky
environment for vector-borne diseases. Strategic stockpiling of drugs for
epidemic-prone diseases such as dysentery or cholera is also necessary
To date, more than 70 WHO staff and consultants are fully
deployed in the relief work at the three most effected countries namely Indonesia,
Srilanka and Maldives.
78 technical guidelines, outlining best practices in the situation, have been
produced, transmitted to the field and posted on the web. Vaccines and
life-saving drugs have been procured and stockpiled in the field.
Reconstruction
phase:
Now that the emergency phase is passing, WHO has been
leading the health response to Tsunami. More elaborate health assessments are
being conducted and, with the aid of helicopter support, health assessments
are being conducted in areas, earlier inaccessible. Increasingly
comprehensive surveillance systems are being established in all countries.
Laboratory capacity is being strengthened, availability of equipment, drugs
and vaccines to support outbreak containment is increasing. These actions
have started providing epidemiological data to identify outbreaks early and
respond rapidly.
WHO is moving to provide technical guidance for the
rebuilding of the public health infrastructure. The access to health care,
referral and transportation of life saving medicines and vaccines has been
profoundly disrupted in many areas, where substantial numbers of health care
workers either dead or left the area. Re-establishing the capacity of health
system to provide basic services and interventions in core areas such as
communicable disease control, maternal and child health, water and
environmental sanitation, and immunization now remains the top most priority.
WHO is informing and educating the public on issues like
personal hygiene, environmental sanitation, and use of health services
established for disease prevention and treatment, which would reduce
mortality and morbidity, particularly among the most vulnerable, such as
children.
For further
information
Relevant
websites: http://www.who.int
http://www.whosea.org
WHO Public
Communication Contacts
WHO Geneva: Mr. Iain Simpson at simpsoni@who.int
and 4122 791 3215
WHO SEARO: Mrs Harsaran Pandey at pandeyh@whosea.org
and 9111 2337 0971
Indonesia : Jakarta: Mr. Chris Powell at powellc@who.int and 4179 217 3425
Aceh: Mr. Robert Dietz at dietzr@whosea.org
and 62 0815 1351 3039 and 62 0651 6370 28
Thailand: Ms Aphaluck Bhatiasevi at Aphaluck@whothai.org and 661 815 1226
Ms Elaine Chatigny, details tk.
Sri Lanka: Mr. Roy Wadia at roy@whosirlanka.org and 94 777 776 112
Maldives: Mr. Randy Grodman at grodmanr@whosea.org and 960 776 911
This
report was prepared under the technical guidance of Dr. Guenael
Rodier, WHO Headquarters, Geneva, Switzerland, and Dr. Jai Narain, WHO SEARO, New Delhi, India.
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