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Situation report 9

Tackling urgent needs such as ensuring proper sanitation and clean water supplies and putting measures in place to try to prevent disease outbreaks is critical. As countries assess their needs, coordinating the relief and reconstruction effort and ensuring the right aid reaches the right people at the right time becomes more crucial. WHO's main concern now is to strengthen disease surveillance and an early detection warning system for potential outbreaks.

Key Issues

• Relief efforts are still critical: Some populations in remote areas in Indonesia have still not been reached.
• No outbreaks have been reported.
• Water and sanitation situation still critical. Sanitation issues are of utmost concern.
• Reconstruction efforts starting simultaneously with the relief efforts. Assessments surveys have commenced and future international relief assistance should be targeted around the results of these assessments.
• 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$67 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.
• 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

Injuries and drowning have accounted for the vast majority of deaths experienced so far in countries affected, as stated in the summary table . Injury-related conditions will also account for many of the heath care needs among those requiring medical attention. Appropriate medical and surgical treatment of these injuries is vital to improving survival, minimizing future functional impairment and disability and ensuring as full a return to community life as possible.

Communicable Diseases

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

• Indonesia: No outbreaks have been reported. Surveillance starting today. Case definitions and forms were agreed upon and distributed by WHO/MOH teams as they travel through the field. Surveillance catchment is expected to increase as the teams reach new health care delivery points. Reports will be weekly, with a telephone alert system for diseases with outbreak potential. WHO guidelines for disease control and SPHERE are being distributed by CD-ROM. The MoH is starting a measles vaccination campaign in affected areas on 6 January. However, this campaign will most likely not commence outside of Banda Aceh for another week. Nine cases of tetanus were reported in Bande Aceh. WHO tetanus antitoxin arrived in Aceh today.
• Sri Lanka: No report of outbreak of diseases in any of the camps. Sufficient vaccines are available in the Ampara district should there be an outbreak.
• India: 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. Thirteen sporadic measles cases have been identified, including eight cases in children less than five. This has prompted measles vaccination campaigns.
• Thailand: On January 5, the following cases seeking care were reported: diarrhoea(77), influenza (8), pneumonia (4), dengue (1), and wounds cases (18). This gives cumulative totals of 1159 cases seeking care since the beginning of the crisis. The largest causes for care are acute diarrhoea, pneumonia, DHF, PUO, and 299 wound cases with 2 deaths. No outbreaks have been reported. Three cases of malaria were detected in Phuket province, but these are believed to be unrelated to the tsunami disaster. Vector control teams are working in the area. Number of DHF in Phuket Province was 16 cases in the past 10 days which exceeded the average of 4 cases per week warranted control measure.
• Maldives: 483 diarrhoea , 83 acute respiratory infection, 322 viral fever, and 16 viral fever with vomiting have been reported. No report of outbreak.

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

• Indonesia: The MoH has completed a water and sanitation needs assessment and, based on this information, the UN is contributing 8 mobile water treatment plants, 97 water test kits, and 2000 squatting plates. The Australian Defense Force is running the main water facility in Banda Aceh with a capacity of 20,000 litres per hour. Water supply is still erratic and there are not enough trucks. Several camps require sanitation improvements. More tankers are also required to deliver water to hospitals and IDP camps.
• Sri Lanka: Waste management and sanitation in IDP camps is a concern. Sanitation facilities are deemed inadequate in the Kalmunai district as there are only three toilets for 1000 people. Water tanks are not being chlorinated in Batticaloa district. 3000 squatting pans and 300 shovels arrived from Brussels on 5 January. With the expected delivery tomorrow of chlorine and water purification tablets, the MoH has announced that there are now sufficient supplies of chlorine and water purification tablets in all districts.
• India: In the A&N islands, safe drinking water is a priority. Although some places have safe piped water, many places require air dropped supplies. The water supply is in the process of being restored in the islands. Water quality surveillance in relief centres and affected villages is underway. UN agencies are delivering water tanks, bleaching powder, and chlorine tablets.
• Maldives: The government, with the assistance of the UN, has determined what supplies are needed for an emergency water and sanitation intervention and is moving forward with this. Drinking water situation is improving through the use of shipped-in supplies.
• Malaysia: The government has been sending massive amounts of drinking water to affected areas in an attempt to meet the WHO guideline of 20 litres per person per day.
• Myanmar: UN WatSan teams have been dispatched to three affected districts for evaluation. Safe drinking water is a primary concern as some local drinking water ponds are salinated and some wells were filled with sand.

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

• Sri Lanka: In the Jaffna district, 150 psychosocial volunteers are providing support to displaced woman and children.
• India: Psychosocial support is being set up in 400 affected villages to address trauma among children
• Malaysia: Up to 1,000 children are estimated to have been traumatized by the tsunami. Some may require professional counseling, the and the government has been sending professional psychiatrists.
• Thailand: Three mental health teams (12 persons) have been sent to two districts to survey the mental health situation.

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

• Indonesia: 77 health centres around the Aceh province have been damaged. Rehabilitation of many basic health centres is needed immediately. The German military medical support ship "Berlin" is en route to North Sumatra. Surveillance programmes are starting.
• India: While access to the affected coastal strip areas is good, Armed Forces support is required to access the A&N islands. Government assessments indicate limited damage to the health infrastructure and facilities. The central Indian government has deployed 29 public health specialists, 23 clinicians, 42 general duty medical officers, 20 nurses, and 19 laboratory technicians to the affected regions. The Indian government has delivered 1922.2 metric tonnes of relief materials, including food, drinking water, medicines, tents, and other supplies to A&N (Andaman & Nicobar) islands. UN agencies and NGOs are also delivering supplies.
• Sri Lanka: The government has made an initial assessment that local medical staff is sufficient to meet local needs. Until a final assessment is made (due today) that will identify any gaps, such as for specialists, the government is not encouraging international NGO medical staff. Twenty-two hospitals and 9 MoH offices were damaged.
• Maldives: Extensive damage to the health infrastructure with one out of 6 regional hospitals, two out of 10 atoll hospitals, 14 out of 63 health centers and 20 out of 127 health posts suffering significant damage. Communication problems further hamper an effectively functioning health system.
• Myanmar: Logistics remains a challenge as some affected areas are quite remote and can only be reached by boat.

WHO Country information

Sri Lanka: National Coordination Meetings were attended by WHO. Displaced people are reported to be heading home so the number of camps is expected to drop. Rapid assessment teams are currently in the field and returning on 7 January. WHO in discussion with the government about mental health. *

India: In the past 24 hours, WHO has provided technical support for vaccination campaigns for measles (along with Vitamin A and OPV) for 16,563 children in 14 districts and for typhoid, procured bednets to protect against malaria, processed paperwork for two collaborating centers to provide training and services for psychosocial support, distributed surgical kits, and distributed clinical management guidelines and outbreak prevention and control guidelines for relief camps,

Indonesia: Through the Health Sector Coordination group, teams will be divided into four subgroups: hospital, emergency primary health care, psychosocial and mental health, and information and logistics. WHO has mobilized 81 vehicles for Indonesia and Sri Lanka together.*

Maldives: Good coordination with other national and international health actors in the country via UNCT. WHO is undertaking disease surveillance and response, including establishing an early warning system. WHO is also providing public health guidance on outbreak response, water quality, sanitation, chronic disease management and mental health. 2 doctors and 5 Emergency Health kits arrive in Maldives January 6.

Thailand: WHO Thailand Tsunami Operations Centre went live on January 5. WHO has been investigating potential cases for outbreaks, but none have been identified. 745 soldiers and 129 volunteer teams with 47,708 rescue workers have been mobilized to look for bodies. Many more bodies were found yesterday. Four teams of 50 disease surveillance and response have been deployed to 4 districts. Two aid teams with 23 nurses have been sent to Phi Phi Island.