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Situation report 15

Aceh, where many people have still not been reached by a systematic aid effort, continues to be an acute emergency. Assessments are under way 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 effort 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

• In Aceh, Indonesia, WHO is coordinating all UN organizations and NGOs (29 organizations in total) for public health relief, in assessing, analysing and responding to the public health needs. Consolidated reports will be regularly provided.
• Overall in the region, while life saving relief is ongoing, planning work is increasing for rehabilitation and reconstruction. In Aceh, however, where access remains extremely disjointed, the focus remains on assessment and relief.
• On day 19 since the tsunami, dead bodies are still being found in the water in Maldives.
• No outbreaks reported yet. Based on previous experience, WHO expects an increase in disease in the third week. The fact that there has not been any is a testament to the countries who have been strengthening disease control mechanisms.

Situational Updates

Health Priorities

Communicable Diseases

• India: The Government of India continues to assess and to deal with the requirements for medical manpower and supplies. The central medical teams have attended to approximately 250 000 people at various locations in the disaster areas. Many of them have diarrhoea, fever, acute respiratory infections (ARI), post-tsunami trauma and injuries. The focus of work is on the provision of safe drinking water, proper disposal of excreta, trench latrines and improvement of personal hygiene. All Central Government institutions have constituted teams, including psychiatrists, to be dispatched at short notice.
• Indonesia: The early warning system has now been in operation for one week. WHO is receiving regular epidemiological reports from an increasing number of agencies. An assessment of critical stockpiling for outbreak response is underway. No outbreaks have been reported. Measles immunization campaigns are being implemented in Aceh and Medan, North Sumatra. With current rains, vector borne disease risk can be expected to increase.
• Malaysia: No outbreaks have been detected at disaster relief centers that are still operational. All cases reported as ARI were determined to be common colds. The MOH response has been to 1) Provide medical treatment to disaster victims at hospitals, health centers and disaster relief centers; 2) Prevent the outbreak of infectious diseases, including food and waterborne diseases such as typhoid, cholera, food poisoning, acute diarrhoeal diseases, vector borne diseases like dengue and other diseases like respiratory infections; 3) introduce control measures to anticipate any outbreaks of infectious disease.
• Maldives: No outbreaks or epidemics have been reported. On January 10, the Ministry of Health (MOH) reported new cases of diarrheas, ARIs and viral fevers but said their numbers continue to be within expected range with no upward trend. DOTS treatment for TB was interrupted in affected areas for three to four days immediately after the tsunami, however, it has been reported that the system now re-established and functioning well.
• Sri Lanka: There are no confirmed reports of disease outbreaks. A campaign for vector borne disease control is being planned for all malaria and dengue endemic areas. Extra fogging machines have been ordered from India.
• Somalia: No outbreak of diseases have been reported in the affected areas. WHO and MOH are collecting surveillance data to monitor morbidity and mortality patterns in the affected areas with special attention to assessing the number of cases of watery diarrhea, bloody diarrhea , acute respiratory infections (ARIs), skin diseases, and measles. Emerging health concerns in affected populations include an increase in ARIs, colds, coughs and diarrhoeas in several locations. WHO has also mobilizied polio eradication teams to monitor disease incidences in the catchments area of the three regions.
• Thailand: There are no confirmed reports of disease outbreaks. However, isolated incidence (in the expected norm) of diarrhoeal diseases continue to be reported.

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

• Maldives: The water supply system is stable and five desalinization plants are in place. While this solution was necessary in the short term, for the longer term, it should not replace the traditional rain water harvesting system. The desalination plants that are being donated/procured for this current situation should ideally be kept for emergencies only, as they are expensive to run and maintain.
• Malaysia: Health teams continue to monitor environmental sanitation, safe water supply, food safety and hygiene at displacement camps.
• Sri Lanka: People have started moving to intermediate settlements in Ampara and Batticaloa. There is some concern regarding overcrowding in houses that have taken people in as there are reports of up to three families living in one house.
• Somalia: In affected communities, there are urgent needs for drinking water, safe sanitation, food, medication, and support for the construction and /or rehabilitation of houses and shelter.
• Thailand: Responding to concerns raised by the Thai government, WHO and the Thai-US Collaboration Centre on Disease Control (TUC) will conduct environmental health assessments in areas where corpses are stored, to ensure there is no sanitation risk to local communities.

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

• Sri Lanka: Mental health experts are in the country to assess the situation. A comprehensive report is expected soon.

Health system and infrastructure (functioning health facilities, access)

• India: 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.
• Maldives: Transport of equipment/supplies to affected islands continues to be a constraint as well as storage space at central level. There are few vessels with enough cargo capacity and few boats to transport cargo from vessels to the beach.
• Malaysia: Kedah state government has built 150 temporary homes for tsunami victims. The state health department has begun replacing 642 damaged toilets in affected areas. Pulau Pinang state government has begun rebuilding homes at Tanjung Bungah.

WHO Action for Health In The Crisis

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.

In order to achieve these goals, action taken by WHO is as follows:

India: All the affected districts of Tamil Nadu, except Purdokottai, have completed their measles immunization activity for children 6-59 months. With the support of WHO in the office of district health authority in Nagapattinum district of Tamil Nadu, collation of daily reports of communicable disease surveillance from primary health centres has begun. A WHO Collaborating Centre has been engaged to provide support to improve water and environmental sanitation services for the community affected by Tsunami in Nagapattinam District, Tamilnadu.

Indonesia: WHO has been named the lead coordinating agency for health in Bande Aceh. Through this coordination, consolidated health reports will be available starting tomorrow. WHO continues to provide support to strengthen disease surveillance. An active surveillance for communicable diseases at inpatient wards has been established. WHO's surveillance teams on the ground continue to be strengthened (3 additional epidemiologists arrived in Jakarta yesterday). WHO is leading an assessment of the western coast. The assessment teams (consisting of 4 teams of 4 persons) will visit 2 sites per day for six days (48 sites in total). Assessments will focus on demographic data, water sanitation infrastructure, food security and health services. There continue to be reports of wounds and complicated wounds in Aceh with 9-12 cases of tetanus. Anti-tetanus drugs have been requested.

Sri Lanka: WHO is providing technical support to strengthen the laboratory network. WHO is facilitating delivery of one plane load of medicines from London to Colombo consisting of primarily antibiotics, analgesics & antipyretic, anti-fungal and ORS donated by the pharmaceutical industries to meet the needs of the MOH. The plane is likely to arrive on Friday/Saturday this week. The WHO SEARO Regional Director continued his visit with a field trip to Galle District, assessing health needs in two displacement camps and reviewing the scaling up of disease surveillance activities.

Somalia: The are no functional health posts in immediate affected areas so WHO and other key partners have distributed 4 New Emergency Health Kits (NEHK) and other basic drugs which can serve the primary health care needs of 40,000 people for 3 months. WHO and the MOH are calling for health professionals working in neighboring towns and villages to provide medical aid. The WHO polio teams working in Somalia have been mobilized to monitor disease incidences in the catchment area of the three regions. Surveillance data is being collected to monitor morbidity and mortality patterns in the affected areas with special attention on assessing the number of cases of watery diarrhea, bloody diarrhea , ARI, skin diseases, measles and other EPI diseases

Maldives: There are still transport difficulties in reaching 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. A WHO food safety expert has visited storage facilities and camps and provided on the spot advice. He provided recommendations for improvements in some government storage facilities and prevention of food poisoning outbreaks in camps in Maleh as a result of inadequate hygiene.

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