Situation Reports on South-East Asia Earthquake and Tsunami

South East Asia Earthquake and Tsunami – 11 March 2005

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Last sitrep # 40,  4 March 2005

The focus has been on reviewing the current situation and planning for the longer-term rehabilitation of the health systems.  Health staff and volunteers are being trained to better address the mental health needs of the tsunami-affected population. Hygiene promotion is being addressed with volunteers being trained, and education materials being developed.

Summary

     Over 150 community leaders and health workers have been trained for mental health interventions and community mental health teams will be stationed in 4 districts in Aceh, Indonesia.

     Dental hygiene amongst school children is of concern in Calang, Indonesia where the only dentist perished in the tsunami.

     In Sri Lanka, approximately 90% of the tsunami-displaced have also been displaced in the past by the conflict, leaving them particular vulnerable.

     In Sri Lanka, the results of a survey to assess the water and sanitation situation in transition camps have been released, and facilities were found to be below national norms in some camps.  More water storage facilities, toilets and bathing facilities are needed.

     A one day workshop provided refresher training on psychosocial approaches to 150 “school advisors” in Sri Lanka.

     In Sri Lanka the rice current harvest is expected to yield a bumper crop in the tsunami-affected areas. 

Health Priorities

Communicable Diseases

Indonesia:  According to the Aceh Provincial health authorities, one person died of malaria (Plasmodium falciparum) from Teunom, in Aceh Jaya on 4 March. The patient became ill while traveling from Medan (situated on the eastern part of the island) to the West coast with five others, who were also subsequently reported as having a febrile illness. He was transferred to Medan where he expired. One of the five people who traveled with the patient was also subsequently tested and diagnosed with Plasmodium falciparum malaria.

A Ministry of Health vector survey conducted in Calang revealed that 59 malaria cases were reported in Teunom.  Ninety five per cent of these cases occurred in adults, and 75% were positive for P.falciparum, either as single or mixed infections with P. vivax (11 cases of mixed infections).  There were no malaria cases in children under five.  For the month of February there were 31 cases reported in Calang - no increase.  Larvicide is on order from the Public Health Office.

In Banda Aceh, nine teams, consisting of 186 Mentor personnel, sprayed the homes of more than 193 800 people.  Teams also sprayed the relocation barracks housing 341 family units.

Two measles cases were confirmed from Lamgapang, in Aceh Besar, and Peniti, in Banda Aceh. Measles alerts from Aceh Jaya, Nagan Raya, Aceh Besar, Pidie, and Aceh Utara were investigated, but measles was determined to be unlikely. The third measles vaccination campaign has had a coverage rate at 79.4% in Banda Aceh, and the campaigns will continue in all other districts until 20 March.

Between 28^th February and 6 March 2005, there have been 304 reported cases of acute watery diarrhoea, 21 reported cases of bloody diarrhoea, 23 confirmed cases of malaria, two reported cases of measles and seven reported cases of acute jaundice syndrome in the 14 districts affected by the tsunami in Aceh province.

Sri Lanka:  On 10 March 2005,WHO Sri Lanka reported sporadic outbreaks of dengue in Trincomalee and Kinniya ministry of health (MOH) areas. A malaria outbreak in Illupankulam in the Trincomalee MOH area was also reported, although no specific numbers were available for either disease. Various control measures have been initiated by local health authorities, such as periodic spraying of insecticides, re-treatment/distribution of insecticide-treated mosquito nets, and currently the number of cases shows a declining trend.

WHO Sri Lanka also reported 32 cases of viral hepatitis in children aged 2-12 years, from Central Dispensary, Sampoor and Thileepan hospital, Pattalipuram. Only 4 of these cases were reported from Tsunami welfare centers. All the affected children had eaten illegally manufactured ‘Ice pops’ and ice creams brought from Muthur Town. These products have been implicated as the source of an out break of viral hepatitis in Muthur Town in 2004. Sampoor and Pattalipuram area have since banned the sale of these products. Drinking water is being chlorinated systematically and health education programs have been intensified.

India, Myanmar, Thailand, and Maldives:   No communicable disease outbreaks or unusual events have been reported.

Health System and Infrastructure

Indonesia:  The District Health Office (DHO) announced its intention of securing prefabricated materials for temporary DHO office and staff barracks in Calang, Aceh Jaya.  WHO agreed to source the materials and to organize their delivery to Calang, which is expected to be in the third or fourth week of March.  DHO reported that 28 district health staff have returned to Calang.  Although their living conditions are suboptimal, they are available to re-start local health programs in conjunction with NGOs.

WHO has distributed Bahasa and English versions of the Weekly Surveillance Report Forms for inpatients and outpatients at the weekly coordination meeting. 

Cap Anamur expressed interest in supporting the rehabilitation/restoration of a Puskesmas(health center) or Pustuin the Calang area.  The DHO has encouraged the initiative.  WHO reported the existence of a comprehensive spreadsheet database in Banda Aceh , of all provincial health facilities and partner organizations involved in restoring them.  In order to identify persisting gaps and avoid overlaps, WHO will seek a copy of the database for local use. 

In Meulaboh, local authorities are sorting and making an inventory of stock, including foreign donated medicines. In Calang, District Health officials are drafting a plan to build a suitable temporary warehouse on the site of the destroyed warehouse.  The high ambient temperature in the storage tents is posing a problem, as this may adversely affect many valuable medical supplies. Hence all groups holding medicines are being asked to ensure effective management of temperature.  Preparations are underway for a planning meeting for pharmacy and medical supplies required for the province. The meeting will bring all districts together with provincial and national ministry of health officials, with support from donors.

Sri Lanka:  On 7 March 2005, UNICEF signed a memorandum of understanding with the Ministry of Health for the rehabilitation/reconstruction of health facilities in 34 locations in 10 districts.  This will result in improved facilities for deliveries, neonatal and primary health care, (including the cold chain) services.

Nutrition, Food Safety and Security

Indonesia:  In Calang district, Aceh Jaya, Action Contre La Faim (ACF) is conducting a nutritional survey.  According to a statement by the District Health Officer,  there is little historical data on the nutritional status in the district, but there appears to have been little acute malnutrition before the tsunami.

Sri Lanka:  World Food Program (WFP) reported that the current rice harvest is expected to yield a bumper crop. Better than average harvests are forecast in the tsunami affected districts of Ampara and Batticaloa in the east, Hambantota in the south, and Polonaruwa and Anuradhapura (the latter two districts have not been affected by the tsunami). WFP is sending specialists to Ampara and Batticaloa to determine if it is possible to purchase local rice for its relief operation.

Preliminary findings of the nutrition survey, completed at the end of January, indicate that 20% of tsunami-affected children are stunted (height for age) compared to the national figure of 14%. While these figures can also be found in non-tsunami affected areas, the higher risk of disease and the absence of natural sources of food, puts displaced children at a higher risk of malnutrition.  Sixteen per cent  of the children suffer from acute malnutrition (wasting) compared to a national figure of 14%. The prevalence of acute malnutrition in the East (19.8%) and West (18.1%) were higher than the North (12.7%) and South (12.8%).

The survey also assessed disease morbidity and the availability of food for the displaced population. The findings indicate that more than two-thirds of under five year olds had acute respiratory infections and nearly one in five children had diarrhea. While latrines were generally available in the camps, only 25% of the population used them. The displaced population is from fishing communities with a low tradition of latrine use. Although the general food distribution for adults is adequate, children do not get appropriate supplementary food. Triposha – a blended food rich in micronutrients, is only available to 14% of under five year old children. Corn Soya Blend (CSB), although available with WFP in adequate quantities at the national level, has not yet been distributed, due to logistical delays and the need to train health workers in distribution and monitoring. Although vitamin A capsules are readily available in the country, only 23% of children received vitamin A supplements.

A vitamin A supplementation campaign in tsunami-affected districts will commence on 2 April, following the results of the nutrition survey, which revealed that only 23% of children in camps had received vitamin A supplementation over the last six months. The campaign will target all children in tsunami-affected districts. Over 463 000 children aged 6 months to 5 years will benefit from vitamin A supplementation.

Environmental Health

Sri Lanka:  The WHO water and sanitation advisor visited Galle and advised the local authorities that WHO could consider providing support in the following areas:

     Detection of leakages in water distribution pipes and minor repairs to avoid on line contamination

     Chlorination of the water supply and ensuring safe quality of water

     Water quality monitoring and surveillance

     Vector control measures

     Maintenance of community toilets (with community support) and cleaning of blockages in the open drainage lines

     Support for solid waste disposal (providing garbage bins and collection of waste for safe disposal) and

     Local capacity building and hygiene promotion programs.

The United Nations Children’s Fund (UNICEF) has released a survey on the water and sanitation situation in internally displaced persons (IDP) transit camps in the tsunami-affected districts.  Although the survey describes a relatively satisfactory situation in general, nevertheless, the water supply and sanitation facilities are below national norms in some of the camps.

Data was collected from a total of 319 camps and include the expected figures in Jaffna, Kilinochchi and Mullaitivu where the transit camps are under construction and expected to be ready by the middle of March. There are large numbers of camps in Galle (68), Trincomalee (62), Ampara (61) and Batticaloa (44). The total camppopulation is reported to be 27 739 families with the largest contingent in Batticaloa, Ampara and Trincomalee.  The average size of a camp is about 87 families with Batticaloa (146) and Mullaitivu (140) having the largest camp populations.

There are 45 different agencies working in the water and sanitation sector.  Coordination between stakeholders at the district level is reportedly good. Additional coordination efforts are required for the establishment of adequate hand washing and waste disposal facilities, and for hygiene promotion. The largest number of agencies handling water, or sanitation, or both, are in Ampara (20), Batticaloa (15), Galle (15) and Trincomalee (10).

Water

Safe water supplies are available to all camps in the affected districts, although the quantity varies substantially.  Jaffna, Killinochchi and Mullaitivu district camps are expected to be the best served with approximately 175 liters being available per family, while Batticaloa, Trincomalee and Ampara are the least served, with only 29 liters available per family (the norm is 100 litres per family).  

Facilities for safe water storage in camps are quite good in all districts except Batticaloa and Trincomalee which have the majority of the IDP population. There is an urgent need for an additional 1200 water tanks in the camps.  As summer approaches, however, more water bowsers and additional quantities of water treatment chemicals will be needed in the camps to meet the expected increase in demand for water.

Bathing facilities are still very inadequate, and fail to provide one unit per 20 persons.  Considering the size of the camp populations, an additional 4500 facilities, or spaces, need to be created for bathing.

Sanitation

The sanitation situation is reasonably good in most districts, where approximately 5,000 toilets exist. In Killinochchi, Jaffna and Mullaitivu, new toilets are being constructed in the transit camps on the basis of one toilet for 2 families, i.e. one toilet for 8 persons. The national norm is one toilet per 20 people.  Based on the camp population size, Trincomalee, with 667 people, has the greatest need for toilets, followed by Ampara (661) and Batticaloa (472).

Almost all camps in each of the districts have a group supporting waste disposal.  Once disposal is managed in a satisfactory manner, there will be a need to construct additional waste disposal facilities for solid waste and drainage in the camp.

Gully emptying has continued during the last two months, with increasing numbers of ‘gully emptiers’ being used.  The disposal for human waste collected by the ‘gully emptiers’ is becoming an issue, however.  The Government, UNICEF and the Non-Government Organizations (NGOs) are in the process of developing guidelines for the safe disposal of human waste.

Mental Health

Indonesia:  A team from the Ministry of Health has conducted training for community leaders and health workers. One hundred and fifty community leaders have been trained, and three posters and leaflets are being prepared.  A proposal to assist the mental hospital to restart their clinical activities is being developed. In a planned pilot project, four community mental health teams will be placed in four districts. Five teams of researchers from the Department of Psychiatry, University of Indonesia are conducting an epidemiology study of mental disorders.

Local mental health professionals and psychiatrists from the Ministry of Health will conduct group sessions with all the staff of Zainul Abidin Hospital.  Follow-up counseling and psychiatric treatment will be offered for those who have significant distress. 

Sri Lanka:  UNICEF reported that the total number of unaccompanied and separated children is as follows:

As parents or relatives have been traced, the number of unaccompanied children has decreased to 27 from 43 reported last week..

UNICEF has drafted a strategic framework for psycho-social activities in Sri Lanka in the post-tsunami context.  Activities cover four main areas of community support services, specialized services for vulnerable groups, direct support for mental health services and district and national coordination for psycho-social services. 

On 7 March, a one-day teacher support workshop was conducted to provide refresher training on psychosocial approaches to 150 ‘school advisors’ who had already been trained by the Ministry of Education, prior to the tsunami.  Among other techniques, the advisors were taught how to facilitate group discussions with teachers working in tsunami-affected districts.

Maternal and Child Health

Indonesia:  In Calang, there are concerns regarding the oral health of children surveyed at the school.  There was only one dentist for the whole Aceh Jaya district prior to the tsunami, but the dentist died in the tsunami.  There are now two dental nurses in the area but they are currently unemployed.  Using a toothbrush appears to be a common cultural practice, and hygiene kits with toothbrushes appear to have been distributed in abundance.  WHO Calang will seek details for oral health programming from WHO Banda Aceh and the Public Health Office.

Shelter

Sri Lanka:  Progress in the construction of transit camps is slow, most notably in the districts of the North East. As a result, many IDPs have been pitching tents on their own in areas with limited access to basic services in Jaffna, Batticaloa and Trincomalee.  In Muthur division, Trincomalee, finding available land is difficult. In Echilampattai, where ample land exists, roads are not suitable for the convenient delivery of relief items.

Of the estimated 73 000 people in the Northern region who are living in camps or with friends and relatives, approximately 90% of the Tsunami-displaced had also been displaced in the past due to the conflict. The majority of these people were displaced more than once, leaving them particular vulnerable. 

In Vaddamarachchi East in Jaffna, 16 transition centers are being constructed and 19 are nearing completion in Mullaitivu district. Various agencies have highlighted the urgent need to complete construction of these centers so that people can move out of welfare centers, including schools, and normal classes can resume. Five regional offices will be set up to coordinate shelter activities.

Government agents in the Southern Province are acting swiftly to establish transitional shelter for displaced persons given the approach of monsoon season.  The International Organization for Migration (IOM) has begun construction to provide transitional accommodation in Galle, Mullaittivu and Muratuwa districts for approximately 1000 families.

Health Education

Sri Lanka:  Hygiene promotion is an issue that is common to all camps and in all districts. Increased partnerships on hygiene promotion as well as increased activities are required.  In Jaffna, WHO has been identified as the lead agency for facilitating the health promotion sub group under the auspices of the Deputy Provincial Director of Health Services (DPDHS) Office.  As part of the health promotion activities, hygiene kits will be distributed.  A workshop will be held to pool experience/resources/expertise to develop a rapid training program and toolkit for the delivery of the hygiene kits.  Agencies which have developed programs and materials for health education plan to collaborate, to formulate a standardized training module that can be given to volunteers (from all agencies) to conduct hygiene and environmental health promotion in the camp settings. 

Other News

Sri Lanka:  The World Bank has announced a doubling of its commitment to Sri Lankan tsunami relief from 75 m USD in emergency credits and grants to 150 M USD. The Asian Development Bank (ADB) announced that it will reallocate 7M USD from its Rural Financial Sector Development Program for Sri Lanka to an emergency micro-credit program for tsunami-affected people in the country. Norway has approved a 2.9 M USD program with FAO for rehabilitation in the fisheries sector.

The Ministry of Finance and Planning, Government of Sri Lanka, held a meeting on 7 March with the NGO community to mark the launch of its Centre for Non-Governmental Sector (CNGS) and to discuss issues of NGO involvement in post-tsunami relief and reconstruction.

The second phase of the needs assessment leading to the formulation of the ‘Recovery and Reconstruction Plan’, led by international financial institutions, will be launched this week.   This will be marked by government participation and by visits to the fields by inter-agency teams. The focus of this second phase is to establish implementation mechanisms that respond to the needs identified in the initial damage assessment.  Three WHO staff participated in a two-day training of team members which took place last week.

In Batticaloa, a protest was held by students and teachers of the three schools still housing IDPs. Government authorities came to the site and explained to the protesters that the IDPs would be moved out of the schools by 14 March.  Data regarding their preferences for relocation is being collected. It has been observed that the IDPs at the schools are becoming increasingly agitated and that the usage of alcohol by both men and women is on the rise.

According to UNICEF, the price of items in the local market has increased considerably. Computers and generators, for example, are double the price of equivalent goods from abroad, even with the inclusion of freight charges. Domestic prices are increasing as a result of sizable purchases in response to the humanitarian emergency. There is also a shortage of building materials.

Unrest has been reported in parts of Trincomalee, where various communities clashed over where to construct temporary shelters and where some displaced people had put up temporary houses in a highly disputed stretch of land near the beach. The situation was tense on 3 March as people blocked roads in the main town, threw stones and burned tires. A court ruling on the same day ordered that the construction stop immediately.  There were no injuries reported.  The situation has now calmed down.

Mine clearance of all transition camp sites, plus a surrounding 100 meter buffer zone, has been completed in both Mullaitivu and Vaddamarachchi. A few unexploded mines (UXO) were found in the wider vicinity of the camp areas. Mine Risk Education programs are still required and are ongoing.

WHO Tsunami Task Forces are established at HQ, SEARO and affected countries to support affected Member Countries and respond to emerging issues associated with the region-wide emergency.  More information on WHO activities and media are detailed at: www.who.int and http://www.searo.who.int/index.htm