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Situation report 17

While the focus remains on acute relief efforts, rehabilitation and reconstruction are gaining momentum in most areas. WHO has begun helicopter-assisted rapid health assessments along the western coast of the Indonesian province of Aceh. These assessments will look at a range of vital health needs, from water and sanitation to injuries, food supplies and the needs for vaccines.

Summary

• Helicopter-assisted rapid health assessments have commenced in the otherwise unreachable western coast of Aceh. The first assessment covered the villages of Tui Kareng and, Tanoh Aceh. As a result, WHO will work to have this area covered by the disease surveillance and early warning system and be provided with water chlorination tablets, hygiene kits, and basic tools for digging latrines. WHO also recommends that malaria treatment and control be put in place as well as a strategic plan to support existing health facilities.
• Sanitation infrastructure remains unsatisfactory in parts of Sri Lanka, particularly in Ampara.
• No disease outbreaks have been reported anywhere in the region.

Situational Updates

Health Priorities

Communicable Diseases

• India: So far, no major outbreak has been reported. The Ministry of Health (MoH) is monitoring the situation with WHO support.
• Indonesia: No outbreaks or epidemics have been reported. Due to a report of sporadic measles cases in Meulaboh and in North Aceh, a large-scale vaccination campaign is underway targeting 1.16 million children aged 6 months to 15 years of age. Considering the high malaria risk in affected areas, WHO is working with local and international health partners to control mosquito breeding sites, spray inside dwellings and other buildings, distribute insecticide treated bed nets and provide adequate supplies of effective anti-malaria medicines. In the most remote areas of western Aceh, no immunization activities or spraying of residual anti-malaria chemicals has taken place since the disaster. Wherever disease surveillance is in place, rumours of cases and outbreaks are rapidly investigated. WHO, the Global Outbreak Alert and Response Network (GOARN) and the MoH are strengthening surveillance with a more comprehensive Health Information System, including mapping and a surveillance & alert database. Hospital and public health laboratory-based surveillance is expected to be in place by January 17, 2005. A mobile public health laboratory is being assembled and should be operational by the beginning of next week. A laboratory is also now operational in Banda Aceh hospital.
• Maldives: There are no reports of epidemics or outbreaks. Daily reporting of 12 communicable diseases from all the atolls and regional hospitals has commenced. A further 23 communicable diseases will be notified if detected. A vector-borne disease control campaign is being planned for all malaria and dengue endemic areas.
• Somalia: Coastal population gathering in relief camps where there are unconfirmed media reports of increased cases of malaria, typhoid, and respiratory tract infections. UNICEF has immunized 200 children from Hafun against measles. On Tuesday, a tetanus vaccination campaign will commence for all women of child-bearing age.
• Sri Lanka: No disease outbreaks are reported. Daily disease surveillance mechanism is very effective in Jaffna. However in Trincomalee, WHO recommends that surveillance mechanisms be strengthened by simplifying the reporting system and including private practices, hospitals, and outpatient departments. Three basic public health laboratories in Kalmunai, Batticoloa and Ampara are being established to diagnose epidemic-prone diseases and to test water quality.
• Thailand: No reports of disease outbreaks or epidemics. Daily disease surveillance is focusing on risks of dengue fever outbreak. Five dengue cases were reported on January 13, 2005. There continue to be cases of diarrheal diseases but these remain within the normal range. The Disease Control Department vaccinated children for measles in the four hardest hit provinces (Krabi, Phang Nga, Phuket and Ranong).

Health system and infrastructure (functioning health facilities, access)

• Indonesia: In the village of Tanoh Aceh, two nurses are working in the undamaged health post. International Service Partners have set up a temporary clinic with 11 staff (six medical and five support staff). They have seen 175 patients in the three days since it opened, most with soft tissue injuries, infections, cuts and lacerations, post-traumatic stress disorder and chronic illnesses such as hypertension. Two cases of bloody diarrhoea with high fever were reportedly seen although the specific agent was not determined. Five cases of tetanus and two suspected cases of tuberculosis were also diagnosed. In the village of Tui Kareng, the health centre is relatively unscathed but heavy debris needs to be removed. Supplies are limited. One local doctor, at least two local midwives, and some local nurses are still present. Two NGOs have established medical clinics in the town, but neither provides outreach health services to the community. People reported gastro-intestinal problems and diarrhoea but no further details are currently available.

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

• Indonesia: In Tanoh Aceh, there are currently 713 local resident and 879 IDPs (259 families), 14% of them are children under five years of age. Many IDPs would like to return to their original villages but refrain due to lack of shelter, reduced means of subsistence and fear of another earthquake in their former communities. Drinking water is supplied either in bottles from airlifts or from open, hand-dug wells. Although there is sufficient quantity of water in the area and local people boil well water prior to consumption, disinfection of wells should be considered. There are insufficient sanitary latrines, e.g. the school, which is housing about 100 people, only has one public latrine. In Tui Kareng, nearly all structures up to 2km inland have been destroyed. There is no power although small generators have been provided by an international NGO for the health centre. Wells are now heavily contaminated with salt water, mud and debris and people collect water from a river and are not boiling it. The river is also used for washing and defecating. Some water purification tablets were reportedly distributed, but these are now finished. Many residents reported diarrhoea and gastro-enteritis. Delivery of soap to both villages should be given priority to improve overall hygiene.
• Maldives: Two United States ships with approximately 100 soldiers are expected to arrive next week to work on water purification.
• Somalia: The Somali Red Crescent Society and UNICEF are providing household chlorination and importing bottled water.
• Sri Lanka: In Ampara, 133 latrines are being constructed. Displaced people continue to leave camps reportedly because they are concerned that they could lose their land if they do not return. However, WHO is concerned that they may be returning to homes which lack proper water and sanitation. Some people are also constructing temporary houses on government land where access to safe drinking water and sanitation could be a problem.
• Thailand: According to press reports quoting the public health authority on the island of Koh Phi Phi, rats may pose a significant risk to public health. Public health officials intend to use traps to deal with the problem of rats returning from the hills.

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

• Indonesia: Thirty-nine cases of tetanus have been observed in Banda Aceh among patients injured during the tsunami. In Tanoh Aceh and Tui Kareng, both remote areas in western Aceh, a number of babies have been born since the tsunami and all are alive.
• Maldives: The Ministry of Health has requested WHO to provide technical guidance to develop a plan of action for psychosocial support to the community.
• Sri Lanka: WHO is assisting the government with psychosocial support to the affected population. UNICEF continues the registration of unaccompanied and separated children with a focus on previously missed children living outside the camps. They are expected to release more figures today. Thailand: The Mental Health Department is deploying psychologists and counselors to villages affected by the disaster. WHO has been requested to provide technical expertise and guidance in the areas of post disaster mental health rehabilitation, particularly among children. The media reports that more than 800 survivors risk severe disability as a result of the tsunami.

WHO Action

Indonesia: For relief in Aceh, the first step is to determine the most urgent health needs. Although good information is currently available from the town of Banda Aceh and the area immediately around it, elsewhere, information is limited or unavailable due to insecurity, impassable roads, and broken bridges. Therefore, the Indonesian government / inter-agency rapid health assessment team moved from Banda Aceh to the aircraft carrier USS Abraham Lincoln on January 13. From this base, four helicopter-assisted teams will make a systematic assessment in four geographic zones extending 10 km inland from the west coast of Aceh. Assessment criteria and an information management system have been developed. The first two missions to Tui Kareng and Tanoh Aceh took place on January 15. Based on these missions, WHO will work to include this area in the disease surveillance and early warning system and work with the US military to provide water chlorination tablets, hygiene kits, and basic tools for digging latrines. WHO recommends that a strategic plan to support local health facilities should be put in place along with a special focus on malaria treatment. The malaria treatment and control should include the provision of artemesinin-based combination therapy for malaria, rapid diagnostic tests, new emergency malaria treatment protocols for medical NGOs, and indoor residual spraying with pyrethroid insecticide.

Sri Lanka: Three WHO sub-offices are being established in Galle, Ampara and Jaffna to strengthen disease surveillance, water, sanitation and mental health activities.The field teams for the Galle and Ampara sub-offices are in place.

Thailand: A WHO Intercountry Crisis Support Unit for Tsunami Response has been set up in Bangkok to strengthen inter-country emergency activities with other UN agencies.

MAP: Communicable diseases collaborating centres

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  WHO communicable diseases collaborating centres in tsunami-affected areas

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