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Situation report 14

Aceh, where many people have not been reached by a systematic aid effort, is still an acute emergency. Assessments are starting and once this information begins to flow, appropriate health responses can be formulated. In Sri Lanka and the Maldives, plans for rehabilitation are being developed, alongside the continuing relief. Much of the initial rescue efforts and the current relief and rehabilitation work has been done by the people and governments of the region. The role of WHO is to assist national and local authorities in this ongoing work, helping affected people and rebuilding damaged communities and infrastructure.

Summary

• Acute relief efforts continue, particularly in Aceh, Indonesia and parts of Sri Lanka. Aid is hampered by the difficulties in accessing certain key areas, and transportation and logistical challenges.
• Access to safe water and sanitation remain critical, particularly in Aceh and the areas of Ampara and Kalmunai in Sri Lanka, where sanitation infrastructure remains inadequate.
• WHO is continuing to provide technical support to affected countries, while coordinating the public health response with other UN organizations and NGOs.
• Planning is getting under way for rehabilitation and reconstruction. However, the acute life-saving efforts remain the overall priority. WHO is assisting in the provision of psychosocial support to affected populations.

Situational Updates

Communicable Diseases

• India: No outbreaks of communicable diseases have been reported. The situation is being monitored by the Ministry of Health (MOH) and state administrations with support from WHO. A medical team is visiting Tamil Nadu, Kerala and Pondicherry to look at ways to strengthen the Integrated Disease Surveillance Programme. There has been an extensive immunization campaign on the mainland; vaccines and AD syringes have been airlifted to the A&N Islands.
• Indonesia: No outbreaks reported. Food security, military security, and infectious disease security remain the priorities. The MOH is strengthening disease control with bilateral support from Denmark in the form of entomology, epidemiology water/sanitation expertise.
• Maldives: No outbreaks or epidemics have been reported. On January 10, 2005 the Ministry of Health (MOH) reported new cases of diarrhea and ARI but said their numbers continue to be within expected range with no upward trend.
• Sri Lanka: There are no confirmed reports of disease outbreaks though independent verification has not taken place. A team of WHO epidemiologists is starting to strengthen the disease surveillance system at district level.

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

• Maldives: The water supply system is stable and five desalinization plants are in place. WHO continues to provide technical expertise in relation to water quality/testing, sewage system restoration and the need to conduct geological investigations of the water lens on the affected islands. A WHO food safety expert is assessing safety aspects of food storage facilities at ports, in transit and in Maleh relief camps.
• Sri Lanka: WHO field teams will liaise with local health authorities on minimum standards for camps as no guidance appears to have been issued yet to local health officers or camp managers. WHO is coordinating with UNICEF and Oxfam to improve water and sanitation and is focusing on water quality surveillance, hygiene promotion and training for field staff. 50 temporary latrines are being installed per day.

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

• India: WHO is leading the UN team to provide psycho-social support for populations in the affected areas.
• Maldives: In response to a request from the Ministry of Health, WHO will coordinate work with UNICEF to asses the nutritional situation of children on the islands. Results from a World Food Programme (WFP) study of children under five years of age are awaited.      
• Sri Lanka: Two mental health experts have been deployed. Work is beginning on developing psycho-social counseling in cooperation with UNFPA, UNICEF and other health partners. Supplemental food rations in camps with corn soya blend for all children less than ten years of age will be commenced.

WHO Action

WHO is focusing its immediate response around five pillars:

• Communicable disease early warning, surveillance and response: Countries are on the alert and monitoring for possible outbreaks, especially diarrhoea, malaria, dengue, tetanus through disease surveillance and verification. No outbreaks reported.
• Public health strategies and action: Based on the ongoing assessment, WHO is focusing its support on providing technical support for water, nutrition, sanitation, immunisation, environmental and mental health, women's health and injuries.
• Ensuring access to dependable health services: Reconstruction efforts starting simultaneously with the relief efforts
• Sustaining an effective health system supply chain: More than 20 logisticians have been deployed
• Coordinating health actors: WHO is working with the MOH to support health actors to address the situation at a local level.

WHO's immediate and medium term focus is on supporting local and national authorities to repair and rehabilitate health systems.

On 11 January, the Director General of WHO attended a ministerial meeting on humanitarian assistance in Geneva chaired by Jan Egeland, the UN Undersecretary General for Humanitarian Affairs. Over 65 attending member states displayed great compassion and solidarity for the relief and recovery. Less than one week after the launch of the Flash appeal, $738 million has been pledged for the overall humanitarian effort.

WHO is also extending an operational platform, consisting of office space, IT infrastructure, and human resources management from the capital cities to affected areas. As this platform becomes operational, more experts from WHO, GOARN, and other partners can be put in the field to work on disease control, mental health, water and sanitation, and technical experts. WHO has also shipped 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 diarrhea kits, each one covering 100 severe cases. 81 vehicles have also been mobilized.

Map

New Emergency Health Kits (NEHK), diarrhoeal kits, and surgical kits (needed/delivered as of 11 January 2005)

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WHO Country information

India: WHO continues to strengthen the Integrated Disease Surveillance Programme in the affected areas in order to rapidly identify any potential disease outbreaks and provide technical assistance to strengthen routine immunization programmes and decrease morbidity and mortality in children. Medical teams have been deployed to the affected areas, including into Andhra Pradesh (158 medical staff), Tamil Nadu (581 medical staff), Kerala (233 medical staff), Pondicherry (87 medical staff), and the A&N Islands (144 doctors, 96 nurses/paramedics, 120 hospital beds, and 10 army/navy medical teams). 742 metric tons of food and 724 metric tons of water have been delivered to A&N islands.

Indonesia: Thanks to WHO's collaboration with the MOH and the 29 partners known to be on the ground, a basic EWARN (Early warning) electronic disease outbreak surveillance system is being put in place. Public health surveillance lab capacity will be available in Bande Aceh in two days time.

Somalia: A UN inter-agency response to the humanitarian crisis affecting Somalia is being planned for this week. Its goal is to collect information on the progress made by WHO for the health response activities and to gain insight for further action to promote recovery of life support systems.

Sri Lanka: WHO, MOH and operational partners are strengthening public health lab backup and a basic EWARN (early warning) electronic disease outbreak surveillance system in the affected areas. The MOH developed emergency reporting forms are in place. The SEARO Regional Director commenced his visit to Sri Lanka, meeting with the country's Minister of Health, assessing public health needs and further discussing WHO's support. Tomorrow, he will travel to Galle for a field inspection, an area particularly affected by the tsunami.

Maldives: A basic EWARN (early warning) electronic disease outbreak surveillance system is being put in place in the affected areas. It is still difficult to reach the affected islands. MOH has requested that visits be limited to only the most essential. WHO is coordinating with UNICEF, UNFPA and the Red Cross to develop a list of medical supplies and equipment that each agency can procure to replace those damaged by the tsunami.

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 Canada (in-kind), China (in-kind), Denmark (in-kind), European Commission (cash), Finland (cash), France (cash), Germany (in kind), India (in kind), Italy (in-kind), Japan (cash), Luxembourg (cash), Norway (in-kind), Kingdom of Saudia Arabia (cash), Sweden (cash), Switzerland (cash and in-kind), the United Kingdom (DFID for cash and in-kind), and the United States (USAID for cash) for recent and early contributions. Expressions of support from individuals around the world are overwhelming.