Humanitarian Health Action

Situation report 4

Regional Office for South-East Asia
Period covered: 1 - 2 January 2005

  • Death toll nearing 150,000 and expected to continue to increase
  • Shortage of clean water is widespread and risk of diseases outbreaks increased throughout region

Major concerns that death rates will rise due to communicable diseases unless priority attention is given to prevention through quality of water and sanitation. WHO does not report any disease outbreaks as yet. WHO focus on health assessments, and is mobilizing emergency health kits to cover essential medical needs of two million people for three months.

Key issues

Health related concern: Depending on endemicity in the affected areas, there is a potential for the following diseases to occur: diarrheal diseases (including cholera, typhoid, shigellosis) hepatitis A and E; and vector borne diseases (including dengue malaria, and leptospirosis). There is an immediate INCREASED RISK of waterborne diseases i.e. cholera, typhoid fever, shigellosis and hepatitis A and E, related to unsafe drinking water and inadequate sanitation (see safe water and sanitation below). Outbreaks of these diseases could occur at any moment. The use of standard treatment protocols in health facilities with agreed upon first-line drugs is also crucial to ensure effective diagnosis and treatment for acute respiratory infections, malaria, sexually transmitted infections and for the main epidemic -prone diseases (including cholera, dysentery, typhoid, hepatitis, dengue, leptospirosis, measles, meningitis). Infection control guidelines should also be in place.

Immediate Interventions related on Water and Sanitation: a) Ensuring uninterrupted provision of safe drinking water is the most important preventive measure to be implemented following flooding in order to reduce the risk of outbreaks of water-borne diseases; b) Free chlorine/ hypochlorite is the most widely and easily used, and the most affordable of the drinking water disinfectants. It is also highly effective against nearly all waterborne pathogens; c) UNHCR and WHO recommend that each person be supplied with at least 20 litres of clean water per day; d) The provision of appropriate and sufficient water containers, cooking pots and fuel can reduce the risk of cholera and other diarrhoeal diseases by ensuring that water storage is protected and food is properly cooked; e) In addition, adequate sanitation facilities should be provided in the form of latrines or designated defecation areas; f) personal hygiene and handwashing is essential to reduce diarrhoeal, skin and eye infections.

Situational Updates

No. of Deaths No. of Injured No. of Missing No. of Displaced Special reports
Indonesia >80,000 >2,500 >1,237 108,083 500,000 without water/food
Sri Lanka 28,551 12,177 5,040 809,246
India 9,063 2862 - Tamil Nadu only 5,511 1,141,000 39 districts affected
Thailand 4,798 10,306 6,384
Maldives 74 1,313 31 9,000 All 200 + Male
Myanmar 59 43 3 200 5 divisions

Logistical matters, including transport, accommodation and communications, are posing serious challenges to any relief efforts. Key focus of the relief efforts in all affected areas is on providing support to survivors, including establishment and operations of welfare centers for displaced people. WFP food deliveries are beginning to arrive in Indonesia, Sri Lanka and Somalia and en route to the Maldives.

Millions of people are now under serious threat of disease outbreaks as a result of damaged water and sanitation systems, sea water contamination, and the congested and crowded conditions of the displaced. No outbreaks of diseases have been reported so far. Countries are gearing up to prevent any outbreaks of diseases.

Health Priorities

Communicable diseases

All affected areas have severe problems of lack of safe water and sanitation. Sewage systems are damaged and several areas are reporting to have only one to two weeks supply of water, and some islands report enough for only 2-3 days (Maldives, Nicobar islands).

Environmental health (access to safe water and hygiene, sanitation situation)

Affected populations show signs of psychological trauma, and reports are coming in on acute anxiety and shock.

Other health issues (Mother and child health, mental health etc)

Damage and destruction to infrastructure is extensive, and many health facilities are damaged in all affected areas. Functioning health facilities are running full speed and additional supplies are being requested. Temporary facilities are being set up.

Health system and infrastructure (functioning health facilities, access etc)

Through the Emergency Health Action Programme for South-East Asia, the financial requirements for WHO’s health response over the forthcoming three-months period is assessed at US$40 million. WHO thanks the governments of the United Kingdom (DFID for cash and in-kind), Italy (in-kind), Switzerland (in-kind), France (cash), and Norway (in-kind) for recent and early contributions. Expressions of support from individuals around the world is overwhelming.

WHO and Coordinated Aid Actions

Country strengthening and supplies
  • Four new emergency health kits now in Sri Lanka and 5 now in Maldives, one cholera kit in Sri Lanka; 190 new emergency health kits mobilized to arrive by mid January; 40 diarrhea kits mobilized; 100 surgical kits mobilized through donation from Norwegian Government to arrive by mid January - covering more than 2 million people for next three months.
  • Ongoing efforts in supply of equipment and drugs, funding and health professionals. Emergency teams deployed to Indonesia, Sri Lanka and the Maldives. Two logisticians deployed to Aceh.
Coordination and technical assistance
  • WHO continues to work with authorities and humanitarian agencies on assessing and coordinating health needs and disease surveillance in Sri Lanka, Indonesia, Thailand and India. Outbreak detection and early warning surveillance through local health authorities, NGOs, and UN Agencies.
  • Most of the countries have 24hour operation rooms in place. WHO’s 24 hour regional and headquarters crisis rooms continue WHO country support. A strong WHO regional team for strategic planning, operational support and medical supply chain management is operating in New Delhi.
  • WHO maintains open partnership and inclusive coordination with UNCT, NGOs and UNDAC in the field and with IFRC, ICRC, IOM, UNICEF and NGOs in Geneva.