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Situation report 8

Tackling urgent needs such as ensuring clean water supplies and putting measures in place to try to prevent disease outbreaks is critical to the speed of the response. Additionally, the aid needs to be targeted. This includes assessing the needs, coordinating the relief, and ensuring the right aid reaches the right people at the right time. WHO's main concern now is to strengthen disease surveillance and an early detection warning system for potential outbreaks.

Key Issues

• Aftershocks are still felt in the affected areas, particularly in Aceh/ Indonesia.
• Funds for relief aid globally have been extremely generous. To adequately address the public health needs of the populations over the next 6 months, a minimum of US$60 million are urgently required. WHO is confident that the international community and donor countries will respond favourably to this appeal. WHO needs this money rapidly to be fully operational on the ground.
• Relief is now reaching more of the affected populations but there are still some areas in Aceh which are not reached.
• Lack of adequate clean drinking water and sanitation facilities, stress and psychosocial trauma and overcrowding in camps contributes to heighten the risks of outbreaks. Cases of diarrhoea are reported and are under scrutiny. No outbreak has been reported yet.
• Although Southeast Asia is the area most gravely affected, humanitarian attention must also be provided to Somalia and the Horn of Africa, area also impacted by the catastrophe.

Situational Updates

Health Priorities

Communicable Diseases

Countries are on the alert and are monitoring for possible disease outbreaks through disease surveillance and verification.

• Indonesia: No outbreaks of disease have been reported, although people in camps in Banda Aceh are suffering from infected wounds, minor injuries, aspiration pneumonia, respiratory tract infection, diarrhea, skin infection, and malaria. The government of Indonesia MoH with technical support from WHO and other agencies has instituted a plan of action for epidemiological surveillance and early warning for outbreaks of communicable diseases. A joint coordination team with the MoH is being established in Banda Aceh for disease surveillance, including mobile laboratory facilities. Measles vaccination was started on 5 January in Banda Aceh.
• Sri Lanka: No report of outbreak. Three cases of diarrhea and 2 case of scabies were reported by WHO personnel in Kalmunai/Ampara. A rumor about measles outbreak in one camp in Ampara was investigated by the government and it turned out to be four cases of chicken pox which have now been isolated. Measles vaccination has been conducted following suspected measles in camps. A rumor of mumps was not substantiated. Isolated cases of diarrhea have been identified in most camps.
• India: So far, no outbreak of communicable diseases has been reported by any of the government agencies operating in the rescue and relief operations in affected states of Andhra Pradesh, Tamil Nadu, Kerala or Andaman and Nicobar Islands.
• Maldives: Health problems are reported as of 5 January from MoH, including: acute diarrhoea (483), viral fever (322), ARI (83) and vial fever with vomiting (16). No other change in the normal disease patterns has been observed so far. The MoH is monitoring possible cases of dengue, cholera, typhoid, shigelloses, Hepatitis A&E, scrub typhus and leptospirosis.
• Thailand: So far no unusual epidemic was found. There are a few cases of sporadic diarrheas but not cholera.189 new cases seeking care reported on 4 January from 6 affected provinces include: acute diarrhoea (121), wound infections (25), respiratory syndrome (18); fever syndrome (10 dengue, for which house visits to identify breeding source). No cholera was reported but a cluster of 3 diarrhea cases is being investigated. Also under investigation are 16 dengue cases in Phuket in the last 10 days and 10 cases of food poisoning. Cumulative cases (26 Dec 2004 – 4 Jan 2005): Reported cumulative number 1042 cases, most were diarrhea (494 cases), wound infection (281 cases), pneumonia (92 cases), and dengue (24 cases). Among diarrhea cases, out of 99 specimens were collected in Phuket and Phang Nga, no Vibrio cholerae 01 detected. There were 2 deaths from aspirated pneumonia and a second case of 76 y.o. female in Phuket with DM and diarrhea and died prior to arrival at the hospital.
• Somalia: The common diseases observed are mainly water borne diseases, measles, trauma and acute respiratory infections.

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

• Indonesia: There are approximately 10,000 camps in Banda Aceh. The largest public health priority remains getting safe drinking water to the population to prevent disease outbreaks. However, reports from the field indicate that camps have been focusing on both safe drinking water and environmental sanitation.
• Sri Lanka: WHO presence in Kalmunai /Ampara indicate water and sanitation facilities are quite satisfactory. However data collected from WHO field presence in Batticaloa reports that there is only 1 water tank for the use of 1135 persons and the sanitation facilities too are in adequate as there are only 03 toilets in this particular camp which is a school, and does not deem sufficient. A WHO team consisting of one EHA expert accompanied by Wat-San expert visited 6 camps in Batticaloa and the general impression is that camp sanitation needs considerable improvement. However, three of six camps are getting the piped water supply from the local water supply system, remaining through the water tankers.
• India: 80% piped water supply has been restored in Port Blair, Nicobar. One drinking water well and four water point have been activated in Car Nicobar. Temporary water supply through one army and one civil well has been resumed. Restoration work for regular supply is under progress in Katchal. In other islands water is available through safe wells/springs and efforts are being made to restore piped water. Air dropping of drinking water is continuing in remote areas.
• Maldives: Severely affected atolls and islands continue to report contamination of water and/or salinity in water. Almost all affected atolls also report blocked or broken sewage systems.
• Somalia: There is one water system and 120 shallow wells. Water systems and sources in all areas visited were partially destroyed. Almost all of the shallow wells observed were completely buried or contaminated by sea floods. The majority of coastal villages do not have latrines due to rocky ground. Villagers use an open ground as a latrine. No health posts/MCHs were seen in all of the visited areas except Bayla and Eyl. Pressing needs are: provision of food aid for six months period; shelter, utensils and clothing, specially for those families who lost their houses; rehabilitation of water systems and shallow wells. Some areas will need water trucking; construction of latrines to improve sanitation; provision of medicines; awareness on sanitation and marine guidance for resettlement.

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

• Indonesia: Psychosocial and mental health problems underlie all illnesses being seen in Aceh province.
• Sri Lanka: The Tamil Rehabilitation Organization (TRO) will provide volunteers to look after the patients. Priority will be given to pregnant women, lactating women, orphaned children under 15 years of age and women and children who have been injured. Lack of basic medical equipment/supplies at the primary health care level is critical, and overcoming difficulty in transportion to the peripheral institutions is the highest priority.
• Maldives: Training of health professionals will be conducted. The training will focus on dealing with the psychosocial needs of the population.
• India: Government of India has deployed 100 medical relief operations in Andaman and Nicobar Islands. Mass immunization campaigns ongoing in the southern states.
• Thailand: Many people have been traumatized and have expressed unwillingness to return back to their villages. The Ministry of Public Health (MOPH) Mental Health Team has been attending to groups of these people. A university psychosocial care expert has coordinated with the MOPH and has mobilized counselors to provide counseling to the affected people.

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

• Indonesia (Aceh Province): Reports from Aceh province indicate that eight hospitals were damaged as well as the Provincial Health Office and 77 health centers. Fifty percent of the health facilities in the province have been destroyed or damaged and half of the provincial health office staff are either dead or missing. Three out of 6 health centers are partially functioning and the Provincial Health Office has reopened in a rented house. No laboratory or blood bank is currently available in Banda Aceh. The camps in Banda Aceh are being served by mobile health services but limited health services are reaching outside. Limited capacity of the warehouse and distribution of supplies are a problem. Staff and medical teams from other provinces have been moved into the area with about 200 health staff in place.
• India: Andaman and Nicobar Islands have the 120-bedded hospital running with 6 doctors, 5 nurses, 1 pharmacist and support staff. Additional teams arrived: 20 specialists, 1 doctor, 3 nurses, 1 epidemiologist, 2 officers, 2 staff. A medical camp is set up at the air strip to treat and evacuate patients. The malaria centre is not functional. Additional supplies have been received including medicines, dressings, chloroquine, chlorine, and halozone tablets, ORS packets were received from Gujarat, Port Blair and IRCS. No shortage in availability of life saving and essential drugs.
• Sri Lanka: The situation of the health service delivery in Ampara district is dire. The Regional Medical Supply Division was destroyed by the Tsunami and all the medical supplies were lost, including all vaccines. In Trincomalee district: (1) Kinniya hospital has been totally destroyed; (2) service delivery is being coordinated between three mobile teams; (3) out-patients department and one delivery room are being established in Trincomalee library. Four hospital buildings in Ampara district have been completely destroyed, including a maternity ward, paediatric ward and labour rooms. The transit centre in Kilinochchi (for underage recruits released by the LTTE) will be temporarily used by the Department of Health as an overflow for women and children from Kilinochchi District Hospital.
• Maldives: Constraints continue to be transport and access to the population disbursed on the islands covering 900 kms. Small groups of residents have preferred to remain on heavily damaged islands and continue to remain vulnerable to the effects of the disaster. Reconstruction of health facilities will be determined by decisions on permanent resettlement.

WHO and Coordinated Aid Actions

Immediate WHO priorities are to deploy more staff (expert areas including, disaster & health, disease and surveillance, water and sanitation, psycho-social, logisticians, etc) in the affected countries quickly. WHO is building up substantial teams in its country and sub-country offices, which have 24hr operations rooms. WHO is working to support national authorities, in collaboration with UNICEF and other major health actors at country and field level. WHO's Global Outbreak Alert and Response Network (GOARN) has been mobilized and is establishing an Early Warning Alert and Response Network (EWARN) for surveillance, verification and response to disease in Indonesia, Sri Lanka, the Maldives, Thailand and India.

Inter agency and global developments

• WHO Director-General Dr Lee continued his mission to the affected region today, traveling to Banda Aceh to further assess the population's need and plan WHO's response.
• The UN Flash Appeal will be launched and an information meeting will take place on 6 January in New York. The Secretary General is in Jakarta in order to launch the Flash Appeal for the relief and recovery efforts.
• The ASEAN Summit with Heads of States took place in Jakarta on 6 January. The agenda included aid coordination, long term recovery and proposed early warning system for the Region. Dr Lee will attend the Summit to present the WHO strategy to protect health following the tsunami, focus on increasing disease surveillance, ensuring access to essential health care, providing technical guidance on essential public health, strengthening supply systems and coordinating the international health response.
• A special meeting on the tsunami disaster will be held on 7 January of the European ministers of health, foreign affairs and development.
• An information meeting will take place on 11 January in Geneva with missions of WHO member states at ministerial level.
• Daily coordination has been established with UNICEF at WHO headquarters and joint action is under way in most country settings
• The Joint Task Force (JTF) Core Team is gearing up and will work out of Bangkok. Jan Egeland has become a member of the Core Group and daily teleconferences between OCHA, the field, the Core Group and military disaster units are taking place.
• IASC information meeting on Indian Ocean Earthquake/ Tsunami in Geneva takes place regularly, attended by FAO, ICRC, World Vision, ICVA, WFP, IFRC, UNHCR, UNDP, UNICEF, WHO and various OCHA desks.
• Margaret Wahlstrom the Secretary General’s Special Coordinator for Humanitarian Assistance to affected countries has concluded her visit to the Maldives.

WHO Country information

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:

• NEHK - 1,900,000 people;
• surgical kits - 10,000 interventions/operations; and
• diarrhoea kits - 40,000 cases

Indonesia: Situation in Aceh is starting to evolve and coordination system improving rapidly. The GOARN has been activated and experts will arrive to start with needs assessment. Drugs purchases are underway. More logisticians and security staff arrived. VSAT in Aceh to be installed. No more need for field hospital for the moment. Excellent coordination among UN and NGOs in country in Jakarta through daily 5pm Donor Coordination meeting led by UNDAF and UNOCHA attended by 30 UN, INGO, and international medical organizations. There is good sectoral coordination for the health sector, education and protection, water and environmental sanitation, Food, Non Food and Logistics, IDPs and shelter. Government coordination meetings led by Minister of People's welfare held daily. There has been high demand on vehicle production companies for vehicles to the region and this has become a major constraint to humanitarian agencies, including WHO.

Sri Lanka: WHO team on the ground, now counting 9 staff including disease specialist, water and sanitation experts, epidemiologists. Further deployment of personnel is arranged during these days. Three sub offices are being established in the affected areas. Four NEHK are available to cater for a total of 40,000 people for three months. WHO rapid health assessment teams returned from the northern districts reported that there are 80 camps of displaced people scattered in the three affected districts. Daily coordination meetings take place at the President Secretariat presided by the Advisor of the President. The MOH holds the weekly coordination meeting and reported that the health situation in camps is under control thanks to joint efforts of Government and the international community. The MOH requested assistance from the international community on rehabilitation and reconstruction. The MOH will provide field medical teams in those places where health facilities are damaged. Six foreign field hospitals are likely to be established in the most peripheral areas with generous contribution from the different countries.

India: WHO has supported immunization in the last 24 hours in Cuddalore District (Tamilnadu), Pondicherry and Karikal U.T. A total of 3,172 children have received measles vaccine, Polio OPV and Vitamin A. Orientation and microplanning completed in: Chennai, Kanyakumari, Nagapattim, Pudukottai, Thiruvallur, Thanjavur, and Villupurum Districts (TamilNadu).

Maldives: Four additional staff have strengthened the country office (logistics, three disease and surveillance experts). Five NEHKs have arrived providing emergency basic health needs for a total of 50,000 people for three months. Ten surgical kits are on the way.

Myanmar: WHO is involved in health coordination, information sharing and needs assessments with the Ministry of Health, UN agencies and NGOs through the UN-Disaster Preparedness and Management Group. WHO continues to provide the Ministry of Health, embassies and INGOs with regular updates and with the relevant WHO normative documents and technical assistance.

Through the Emergency Health Action Programme for South-East Asia, the financial requirements for WHO’s health response over the forthcoming six-months period is assessed at US$67 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 (inkind), Canada (in-kind), China (in-kind) Finland (in cash) Germany (in kind) and Denmark (in-kind) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.