Subnavigation

• Humanitarian Health Action
• Crises
• Technical guidelines
• Key policy documents
• Donor centre
• Global network
• Global Health Cluster

Situation report 6

Providing safe drinking water and adequate sanitation remains the major priority in preventing disease outbreaks. Reported Diarrhoea is being examined, so far ruling out cholera. Cleaning up efforts for the damaged areas has begun and relief camps are being set up, but are hampered by damage. Proper camp design and management to avoid crowding, which might lead to further health concerns, is imperative. WHO is emphasizing to reduce suffering of survivors by providing health and psycho-social care. The immediate WHO priority is in deploying personnel to strengthen country efforts.

Key Issues

• Millions of people are now under serious threat of disease outbreaks as a result of damaged water and sanitation systems, sea water contamination of supplies by seawater and crowded living conditions. The most practical and effective strategy to prevent cholera and typhoid is to provide clean water in adequate quantities and adequate sanitation. Sufficient soap and hygiene education will further prevent the transmission of both diseases.
• Shelters must be placed with sufficient space between them, in accordance with international guidelines aimed at preventing diseases related to overcrowding such as measles, respiratory infections, diarrhoeal diseases and vector borne diseases.
• Cases of malaria could increase in after flooding due to mosquito breeding if stagnating salty water is turned brackish by heavy rains or fresh water from other sources. It is of vital importance to ensure early diagnosis and treatment for fever (within 24 hours of onset). In areas of known malaria risk the following precautions should be taken:
• a) spraying of shelters with residual insecticide and/or retreatment/distribution of insecticide-treated mosquito nets in areas where their use is well-known; b) Water storage containers should be covered to prevent them from becoming mosquito-breeding sites. c) Attempts should be made to eliminate pooled water which may be gathering amongst the debris; d) In areas with open fresh-water containers, larviciding is recommended to prevent breeding of dengue vectors. e) Garbage must be collected and appropriately disposed to discourage rodent vector breeding.
• Information and education efforts should be focusing on: a) promotion of good hygienic practice; b) ensuring safe food preparation techniques; c) ensure boiling or chlorination of water; d) ensuring for individual care that a min. 250g of soap is available per person per month

Situational Updates

Total death toll exceeds 155 000 in the South East Asia region. Indonesia, province of Aceh is hardest hit. WFP estimates that two-thirds of people in Banda Aceh are not receiving aid at all. Australian troops are delivering water to Aceh region.

Millions of people are now under serious threat of disease outbreaks as a result of damaged water and sanitation systems, contamination of supplies by seawater and the crowded living conditions. Infectious diseases, specifically water-/ vector borne diseases (Malaria, tuberculosis, dengue, Japanese encephalitis, diarrhea and acute respiratory infections) were prevalent diseases prior to the tsunami crisis. Patients suffering from chronic diseases (cardiovascular and cerebrovascular diseases, diabetes, cancer, etc) are suffering because of reduced access to health facilities and resources.

Health Priorities

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

Communicable diseases

Except for Nicobar Islands, the position of drinking water supply in most of the affected areas is reported to be normal. Adequate quantity of bleaching powder/halogen tablets have been made available to the affected areas in the mainland. At Nicobar, the possibility of locally available drinking water sources is being explored. 197.18 mt. of water have been delivered as relief supplies in the Nicobar Islands.

• Thailand: Health problems reported include: acute diarrhoea (167), wound infections (163), food poisoning (33), pneumonia (20), malaria (8), Dengue (7).
• Maldives: Health problems reported include: acute diarrhoea (336), viral fever (275), ARI (55).
• Sri Lanka: a) a few cases of chicken pox have been reported in Jaffna district. They have been isolated, and details are ascertained. b) 150 cases of diarrhea have been reported from 30 camps located in Batticaloa district out of which 50 cases are from one camp. Specimens are currently been further examined.
• Indonesia: Diarrhoea cases in Aceh are currently being examined.
• India: No outbreak of communicable diseases has been reported by any of the government agencies operating in the rescue and relief operation. There are however, sporadic cases of diarrhoeal disease reported from affected areas in Tamil Nadu and Kerala. The prevention of outbreaks in the Nicobar group of Islands has been accorded priority; 80 doctors and 20 nurses of Central Institutions are deployed in various islands besides the efforts of Armed Forces; Emergency medicines / disinfections (58.83 tones) have been delivered by 2nd January 2005. 148 specialized medical teams have been deployed in the disaster areas of Andaman & Nicobar.

Environmental Health

Safe delivery conditions are a major concern as health infrastructure and services have been severely disrupted, and in some cases destroyed. In Maldives for example, there are 1500 pregnant women scattered across the 200 islands who have been affected by the disaster. Within six months 1000 of these women will deliver, regardless of the health facilities available (10 atolls hospitals and health centres have been severely damaged and are not functioning while supplies and equipment have been destroyed in an additional 20 health service delivery points).

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, including laboratory facilities. In India for example 111 stationary and 53 mobile medical teams are functional in Andhra Pradesh, 92 Medical camps have been conducted in Kerala.

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

As we move into Week Two of the tsunami crisis, it is imperative WHO deliver on its key role in humanitarian assistance in health. This will require a massive scale up of operations in countries in liaison with national authorities, other UN agencies and the Core Group. The WHO strategy in the responding to the current crisis is:

WHO and Coordinated Aid Actions

Immediate WHO priorities are to get more staff into the region quickly. WHO is building is substantial teams in its country and sub-country offices. WHO is working jointly with national authorities, UNICEF and other major health actors at country and local leval. WHO's Global Outbreak Alert and Response Network: is currently establishing an EWARN and a surveillance verification and response to disease system, in Indonesia, Sri Lanka, the Maldives, Thailand and India.

• Surveillance and response: tracking patterns of life-threatening diseases among those at risk through prompt set-up of a surveillance and early warning system with daily epidemiological reports (immediate mobilization and deployment of GOARN)
• Joint action: Coordination of health actors at local, national and international level, with agreed strategies and joint action
• Public health: providing guidance re critical public health issues (response to disease outbreaks, water quality, excreta management, chemical threats, chronic disease management, mental health): filling critical gaps until others are able to take on the task
• Access to essential health care: work with all partners to ensure equitable access to adequate quality of essential health care through key hospitals and health centres
• Medical supplies: contribute to ensuring that medical supply chains function as efficiently as possible and respond to the needs of end-users

Inter agency and global developments

Further deployment of WHO personnel to Sri Lanka, Indonesia and the Maldives is under way. A total of 190 New Emergency Health Kits (NEHK), 100 surgical kits and 40 diarrhoea kits are in the pipeline to the South East Asia region. Coverage by these kits total: a) NEHK - 1 900 000 people; b) surgical kits - 10 000 interventions/operations; and c) diarrhoea kits - 40,000 cases

• The Director General and Regional Director are currently visiting Indonesia;
• The UN Flash Appeal is to be launched on 6 January. WHO Headquarters, the Regional Office and Country offices in the region are preparing the health component of this Flash Appeal.
• US state officials visit the region to assess damage. Special envoy of UNSG for Tsunami, Margaretha Wallstrom has been visiting Maldives.

Indonesia: WHO and UNICEF staff are establishing a base in Banda Aceh. Housing and one warehouse is in place. Transport, two vehicles and office facilities will also be set up. Staffing on the ground has been strengthened with disaster management, epidemiologist, logisticians, security officers and health experts. Ten NEHKs have arrived meeting basic health needs in crises situations for a total of 100 000 people for three months. Difficulties experienced in telecommunications; Quality of communications is poor and mobile telephone network is saturated.
Sri Lanka: WHO is coordinating health action with government and various organizations, specifically health assessments and plans for health infrastructure. Four NEHK are available providing basic emergency health needs to a total of 40 000 people for three months. Epidemiologists and health experts have arrived in Sri Lanka.
India: a 24hr operations room is in place and staff in all affected States is operating in support of the Government.
Maldives: Five NEHKs have arrived providing emergency basic health needs for a total of 50,000 people for three months.

Country information

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), Canada (in-kind), China (in-kind) Finland (in cash) Germany (in kind) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.