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Situation report 5

There is great concern of disease outbreaks among the affected population of 5 million. It is a race against time to act quickly to respond to disease outbreaks. First reports from health assessments are coming in and so far there are no confirmed outbreaks. Increased reports of outbreaks of diarrhoea are expected and there are concerns for malaria and dengue. Disease surveillance is essential to ensure any potential outbreaks of any disease are identified and responded to rapidly and efficiently. The priority is to ensure the health of the survivors through: treating the injured, ensure availability and access to clean water and sanitation facilities and ensuring essential supply of medicines and trained health workers to easily access affected populations.

Key issues

• Ensuring access to adequate supplies of clean drinking water. This is essential to prevent disease outbreaks, particularly waterborne diseases. Millions of water purification tablets have been sent to the South East Asia region along with technical expertise (sanitation engineers) in efforts to re-build water and sanitation infrastructures.
• Treating the injured and casualties. WHO estimates that more than 500,000 are injured due to this catastrophe. Basic medical supplies to treat over half a million people for three months have been mobilized.
• Improving sanitation and hygiene needs in temporary shelters. Overcrowded living conditions propagate respiratory diseases (such as pneumonia). There is an increased risk of measles, influenza and meningitis outbreaks as well as increased incidence of acute respiratory infection. Diarrhoeal diseases and vector-borne diseases are also increased in overcrowded conditions. Good camp/settlement management is essential to ensure relief reaches all people in a timely manner.
• To ensure the right aid assistance reaches the right people at the right time, a coordinated assessment and response with local governments, other UN agencies, NGOs, donors, private sector and - most importantly - local communities is required. WHO continues to work closely at country, regional and global levels with all stakeholders to ensure adequate coordination efforts and adequate surveillance systems.

Logistical matters, including transport, accommodation and communications, are posing serious challenges to relief efforts. The key focus of relief efforts in all affected areas is on providing support to survivors, including establishment and operations of welfare centers for displaced people.

Health Priorities

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 epidemic outbreaks of diseases have been reported so far, some baseline of water-/ vector borne diseases are normal in the affected area. Mass vaccination against cholera and typhoid fever is not recommended. The most practical and effective strategy to prevent cholera and typhoid is to provide clean water in adequate quantities and adequate sanitation.

Communicable diseases

The surveillance system should focus on the communicable diseases of public health significance most likely to appear in the flood-affected area with the objective of early detection of outbreak-prone diseases. Reports come from different sources with no verification and incomplete and can not be used for proper planning and taking response.

Countries are gearing up to prevent any outbreaks of diseases and through disease surveillance, data are being verified:

• Thailand: Health problems are being reported, including: acute diarrhoea (167), wound infections (163), food poisoning (33), pneumonia (20), malaria (8), Dengue (7).
• Maldives: Health problems are being reported, including: acute diarrhoea (225), viral fever (124), injuries (552), anxiety /shock (152).
• Sri Lanka: Cases of diarrhea are reported in some districts but are very much the expected norm. No evidence of outbreaks yet. Plans for rapid diagnosis of diarrhoea to exclude cholera have been carried out.

All affected areas have severe problems of lack of safe water and sanitation. Sewage systems are damaged and several areas reportly have only one to two weeks supply of water. Some islands report having water supply to last only two to three days (in the Maldives and Nicobar islands).

Environmental health

Affected populations show signs of psychological trauma and reports are coming in on acute anxiety and shock. A single suspected measles case is sufficient to prompt an immediate immunization response. Life-saving measles vaccines should be made available immediately targeting all infants and children 6-59 months of age. The suggested target age group may be expanded up to 15 years, if feasible, in areas where there is substantial overcrowding. Vaccination programme activities should be included as part of basic emergency health care services being is re-established.

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. A major constraint is that health personnel and their families were also affected by this disaster. 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)

WHO and Coordinated Aid Actions

• Germany is setting up a military hospital in Banda Aceh area. Ten bed units with two operating theatres. Units will work in close cooperation with one German hospital ship. An airbus will also be sent to the Banda Aceh area for medical evacuation and medical care of international staff, as required.
• WHO is currently working with governments of affected countries to develop operational frameworks to integrate international expertise into national systems and to further define needs.
• WHO to date has mobilized 330 medical kits containing enough supplies to treat two million people for a period of three months. Surgical kits mobilized to the region and provided by the Norwegian Government contain sufficient supplies to treat two million people for three months. Three VSATs have now been mobilized to Sri Lanka, Maldives and Indonesia.
• WHO is establishing a Global Access Response Network (GOARN) operational support team in Delhi (including staff from the Regional Office and Headquarters) to coordinate the support from GOARN partners. WHO is making contingency plans for the deployment of GOARN expertise to Indonesia, Sri Lanka, Maldives and potentially Thailand. It is anticipated that these operations may also include sub-national teams in some countries. This will be a phased approach that will require sustained support in the field for an initial three-month period. It is envisaged that the critical core capacities will include: team leaders, communicable diseases epidemiologists, laboratory experts and technicians, logisticians, data managers, and risk communication experts in outbreak response.

Interagency and global developments

• The Inter Agency Standing Committee (IASC) South Asia Earthquake/Tsunami meeting will take place on Monday 3 January 2005 in Geneva.
• A session at the World Conference on Disaster Reduction in Kobe, Japan on 18-22 January 2005 will consider how a tsunami early warning system would be developed for the South East Asia region.
• WHO has set up a system allowing individuals to donate funds directly towards WHO's relief efforts. Online donations to WHO have reached a total of 25 to 30,000 USD.
• The WHO Director General will visit Indonesia and Sri Lanka on 3 to 5 January 2005.
• The Asian Summit of Heads of State will take place in Jakarta on 6 January 2005.
• UN Secretary General Kofi Annan will visit Jakarta on 5 & 6 January and will launch the UN flash appeal on 6 January from Aceh.

Country information

Through the Emergency Health Action Programme for South-East Asia, the financial requirements for WHO’s health response over the forthcoming three-month period is US$40 million. WHO thanks the Vienna Philharmonic Orchestra (cash) and the Governments of the United Kingdom (DFID for cash and in-kind), Italy (in-kind), Switzerland (in-kind), France (cash), Norway (in-kind), Denmark (DANIDA in-kind), China (in-kind), Canada (in-kind), Germany (in-kind) for recent and early contributions.

• Indonesia: Nationally, WHO conducted a coordination meeting with MOH, NGOs (international and national) to share information on health activities. WHO main areas of support are in health assessments, disease surveillance and response, water and sanitation, maternal and child health, and mental health. Priority is given to establishing a surveillance system. Staff capacity has been strengthened at country level, and the country Office has quite strong staff support for this mission. WHO and UNICEF staff in Banda Aceh are working together to prepare the warehouse.
• Sri Lanka: Major focus of work is on health coordination with Government, UN agencies and NGOs. WHO rapid health needs assessment team are in Hambantota, Ampara, Jaffna, Mullaitivu, Trincomalee. WHO in Sri Lanka called UN inter agency health sector meeting on 3 January to coordinate health response and with MOH Health Sector Coordination meeting took place.
• India: WHO is running a 24hr Operations room in close collaboration with the Government of India, while staff is active in health relief efforts in all affected States. Focus of work is on health technical assistance, provision of guidelines, surveillance of diseases, provision of training (such as on psycho-social counseling).
• Maldives: water and sanitation experts have started inventory of affected islands
• Thailand: WHO team has carried out health assessments in the affected areas.
• Myanmar: WHO and UNICEF are collaborating to reduce the risk of disease outbreaks and level of morbidity by strengthening disease surveillance, providing emergency medical supplies and supporting the resumption of child immunization services.