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Situation report 10

While calls for and plans for rehabilitation are picking up, the reality in the field remains in some areas dramatic and difficult to access (example: unconfirmed reports of a camp with 60,000 people in Malabeu, Indonesia). Finding the right balance between relief for the dire acute emergency and reconstruction is key. Health actors, supported by WHO are progressing with health assessments and know what is needed technically; The current challenge is the operational capacities on the ground.

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 detailed needs and future international relief assistance should be targeted around the results of these assessments.
• Given the better understanding of needs, donations in kind should be planned in advance in response to an expressed need. Un-requested donations in kind are not helpful at this time.
• 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 drownings have accounts for much of the needs in terms of medical attention. 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, aversion of avoidable deaths due to septic complications of wounds, tetanus, and limitation of long term disability and ensuring as full as possible a return to community life.

Communicable Diseases

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

• 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. Sporadic cases of acute diarrhoeal disease have been reported and investigated. Few cases occurred in a single relief camp in Kollam district and were diagnosed as food poisoning. 32,563 children (6mos-5 yrs) in affected districts received measles vaccinations and doses of Vitamin-A supplement.
• Indonesia: No outbreak reported. 9 cases of tetanus in adults has been reported. Field based disease surveillance in Aceh active as of today. Case definitions have been agreed and distributed, data collection forms have been finalized, agreed, and distributed by MOH/WHO teams as they travel through the field. Surveillance catchments are expected to increase as relief teams reach, and then revitalize, health care delivery points. Reports will be produced weekly, with a telephone alert system for diseases with outbreak potential. WHO guidelines for disease control and SPHERE standards are being distributed by CD-ROM. Rumors of one camp with 60,000 people.
• Sri Lanka: No outbreaks reported. Rumors of measles and cholera have been investigated and determined to be chicken pox. Diarrhea cases also exist.
• Thailand: On January 5, the following cases were reported: diarrhea (77), influenza (8), pneumonia (4), dengue (1), and wounds (18). Since the crisis started, this compiles to a cumulative total of 1171 cases, the leading causes being acute diarrhea, pneumonia, PUO, and wound cases. No outbreaks were reported. 3 cases of malaria were detected in Phuket province, but this is 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.

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

• India: In the A&N islands, safe drinking water is a priority. Although some place, such as Port Blair have safe piped water, many places require air dropped shipments (786 metric tons of water thus far). The water supply is being restored in the islands. Systems for water quality surveillance have been planned for and implemented in relief centers and affected villages. UN agencies are delivering water tanks, bleaching powder, and chlorine tablets.
• Indonesia: Water supply is erratic still and there are not enough trucks. Several camps require sanitation improvements. More tankers are also required to deliver water to hospitals and IDP camps. 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.
• Sri Lanka: Sanitation facilities are deemed inadequate in the Kalmunai district as there are 1000 people for 3 toilets. Water tanks are not being chlorinated in Batticaloa district. With the delivery 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.
• Maldives: Drinking water situation is improving. The government has supplied 2 desalination devices.
• Thailand: Special attention is required in Phang Nga province, where several camps for displaced persons have been set up. Improved sanitation required in camp kitchens. Surveillance system in some camps are urgently required to track down cases.

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

• India: Two WHO Collaborating Centres for mental health and two medical institutions have been engaged to provide training and service in Psycho Social support.
• Sri Lanka: A meeting with the Ministry was held yesterday to discuss the mental health issues currently prevailing in these areas. It was decided that the different interest group would jointly develop a plan to address the mental health issues by 10 January and would give to the MoH for approval. The plan would be implemented through the MoH.

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

• India: Government agencies have assessed the damage to health infrastructure/facilities as limited.
• Indonesia: Norway Red cross deployed a 100 beds hospital with 39 staff. The Health Coordination Working Group that there is already adequate hospital capacity and adequate medical supply and logistic systems. Thus, unless the situation changes (e.g. if IDP camps are established), no further field hospitals are needed now. Medical supply and logistic systems have improved. WHO procured and delivered Tetanus toxoid vaccines.

WHO Action

WHO has five strategic priorities in responding to this event: surveillance, key public health guidance, health systems assessment (damage plus rehabilitation), supply systems, and coordination. In order to achieve these goals, the actions taken by WHO are as follows:

Getting expert people to the theater of operations: The Global Outbreak Alert and Response Network (GOARN) has been activated and 120 expert epidemiologists are on standby. 12 expert epidemiologists from GOARN (from CDC Atlanta, EPIET, and independent experts) plus 10 expert epidemiologists from WHO are either en route to countries or will be deployed early next week. WHO has also deployed logisticians to establish an operational platform on the ground. Sri Lanka and Indonesia each have 5 logisticians on the ground and 1 IT person en route. Maldives has two logistician en route.

Getting supplies to the theater of operations: The first WHO shipment for the emergency response includes 191 New Emergency Health Kits (NEHK), each one covering 10,000 people for primary health care for 3 months, 100 surgical kits, each one covering 100 surgical interventions, and 40 diarrohea kits, each one covering 100 severe cases. 80% of this first batch of supplies will be delivered and in country by the end of the weekend. 81 vehicles have also been mobilized.

Getting funding for the event: WHO has made an appeal for 66.7 million USD and has received so far pledges for 27.1 million USD. We would like to express our gratitude for the continued excellent support from all sectors (and individuals) in responding to the Tsunami and Earthquake Crisis in South-east Asia. As of 7 January, WHO is not in a position to absorb further personnel, medicines and related items for the IMMEDIATE emergency response to the crisis in South-east Asia. We would be grateful if IN-KIND offers could be reiterated in the coming weeks/months, when reconstruction activities are underway and when stock and personnel may have to be renewed or a diverse kind of support is required.

The Director General and the Regional Director have visited the region. The Director General and the Regional Director went together to some of the worst hit areas of Indonesia (Banda Aceh) and then to the ASEAN leaders meeting on recovery in Jakarta. Then the Director General went to Sri Lanka. In Sri Lanka, he was accompanied by Sri Lankan Health Minister and the WHO Representative in Sri Lanka. They called on the President who requested WHO support in health infrastructure replacement and development, treatment and provision of measures for psychosocial trauma in affected areas, and the development of disaster prevention centres.

WHO Country information

India: The Government of India with the states/UTs mounted massive relief and rescue operations in the mainland and A&N Islands. Access to the affected costal strip on the mainland is not an issue. However, access to the Nicobar Islands is more difficult and is undertaken through support of Armed Forces. Power supply in the A&N Islands is based on 715 Diesel Gensets. 41 telephone exchanges are operational WHO established an Operations Room. WHO provided the MoH with clinical management guidelines of common diseases, food safety guidelines, laboratory support to post-disaster communicable disease surveillance guidelines. WHO provided technical assistance for strengthening routine immunization and for further strengthening disease surveillance in affected districts. WHO has placed procurement orders of impregnated bed nets to prevent malaria.

Indonesia: Coordination of health response, strengthening of supply systems, and disease surveillance remain the key issues. Government undertaking health sector coordination with a health co-ordination meeting attended by MOH, WHO, Australian Defense Force, CAP ANAMUR, CARE, Catholic Relief Service, Danish Military Hospital, German Federal Disaster Relief, German Military, Government of Chile, Government of France, Government of Mexico, ICMC, ICRC, IFRC, International Medical Corps, International Rescue Committee, Islamic Relief & Development, Médecins du Monde, Mercy Corps, Merlin, MSF, "Northwest Medical team", Save the Children Alliance, Singapore Military, Spanish International Cooperation, UNICEF, University of Indonesia, UNHCR, and UNFPA. The group will have six subgroups: hospitals, primary health care/surveillance/disease control, mental health, environmental health, nutrition, and reproductive health. The Government of Singapore has continued supporting the provision of space in the flights to Banda Aceh.

Myanmar: The Tsunami Assistance Coordination Group, chaired by the International Federation of the Red Crescent Societies (IFRC) and including WHO, met on 6 January to consolidate findings of the different assessment and verification missions. The group's assessment of the scale of impact is in line with the government's own findings that Myanmar was largely spared from the earthquake and tsunami and that the initial emergency needs have been met by the government and the aid community. Immediate needs are shelter, safe drinking water, food, and non-food items (blankets, clothes, cooking sets, mosquito nets etc). Agencies are coordinating their response using pre-positioned stocks and/or redirecting resources through the coordination group. Future coordination and planning will be ensured by a small liaison group following up on a second assessment phase for mid and longer-term needs and support. The group agreed to undertake an evaluation of the response and coordination mechanisms as apparent in the emergency phase of the current situation in Myanmar, with a view to improving future disaster preparedness and response.

Somalia: The destruction of housing, shelter, water sources and assets and the loss of an estimated 150 lives have further compounded Somalia's long-running humanitarian crises. While a full needs assessment is yet to be completed, initial reports from inter-agency assessments on the ground suggest that 18,000 households were directly and indirectly affected and are in need of assistance. This would include those populations who depend on fresh water sources along the coast and there are indications that this population could extend inland up to 50 kms. The destruction of a number of fishing boats and equipment and the subsequent loss of livelihoods is expected to add to the number of vulnerable people. Humanitarian priorities for those affected include clean water, food, medication, and support for construction and rehabilitation of houses and shelter. Some food and non-food assistance was mobilised in the days immediately following the disaster by a number of operational agencies, but a lack of access, data and operational capacity in many areas has hindered the assessment and assistance processes.

Sri Lanka: Government has placed camp management teams in all camps and is distributing family tents to each family. Similar actions being carried out in North-east restricted areas, in consultation with LTTE, Government, Norwegian Monitoring Mission and NGOs such as Tamil Rehabilitation Organization (TRO). WHO and MoH discussed emergency surveillance system and agreed to share available epidemiologic data and assessments. Several WHO rapid assessment teams are still out in the field and are due to return on 7 January 2005. The Director General of WHO visited Sri Lanka.

Thailand: WHO Thailand Tsunami Operations Centre went live on January 5. Crisis support coming in from Bangkok for entire region including from the interagency office there and a major US military initiative there. Consideration given to US fleet's proposal of providing off-shore operation/accommodation for Aceh.

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 (cash and in-kind), France (cash), Norway (in-kind), Canada (in-kind), China (in-kind) Finland (in cash) Germany (in kind), Kingdom of Saudia Arabia (cash) Sweden (cash) and Denmark (in-kind) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.