Subnavigation

• Humanitarian Health Action
• Crises
• Technical guidelines
• Key policy documents
• Donor centre
• Global network
• Global Health Cluster

Situation report 19

Across much of the affected area, the focus on planning for rehabilitation and reconstruction is increasing. However, in some places - particularly in the north of the Indonesian island of Sumatra - access to the basic needs of water, sanitation, and hygiene is still not adequate. In the district of Aceh, helicopter-based rapid health assessments continue. Disease surveillance continues to be strengthened across the region in order to rapidly identify potential outbreaks.

Summary

• Helicopter-based rapid health assessments continue in previously inaccessible areas of Aceh. Further public health responses in the area must be linked to assessments. Supply chain needs to be reinforced.
• No disease outbreaks have been confirmed in any of the affected areas throughout Southeast Asia. As the risk of outbreaks remain high, control measures are being implemented to rapidly respond to any potential disease outbreaks. Surveillance is key to an effective response as this allows the rapid identification of an outbreak, the first step in responding.
• Vital systems and lifelines remain broken even three weeks after the tsunami.

Situational Updates

Health Priorities

Communicable Diseases

Across the region, WHO has put in place or strengthened existing surveillance systems and has prepared stockpiles and teams of experts to respond in the case of an outbreak.

• India: No outbreaks have been reported. Measles immunization campaigns are a priority. Adequate quantities of medicines, oral rehydration solution and IV fluids are available.
• Indonesia: No outbreaks have been reported. On January 16th, 2005 a third day of assessments along the west coast of Aceh reported on the need for improved water quality and sanitation facilities. The team also recommends a measles vaccinations campaign. One suspected case of encephalitis and 20 suspected cases of cholera reported 40 km south of Meulaboh. The Ministry of Health (MoH) and WHO are sending a team to investigate. The number of new tetanus cases seems to be declining: eights patients hospitalized for tetanus since January 12, 2005, but there was only one case reported in the last three days. Sporadic cases of malaria have been reported, some of which are relapses of cases previously treated with chloroquine. MoH disease surveillance officers will be deployed in all districts of Aceh to strengthen surveillance systems. These systems have been operating for a week and WHO will work with other UN agencies, NGOs and health clinics to bolster themm. Daily hospital (inpatient) and laboratory-based surveillance will begin on January 17, 2005. WHO field office is preparing standard treatment guidelines for epidemic-prone diseases and assessing critical supplies for disease outbreaks. Supplies for cholera are being stockpiled in Jakarta.
• Malaysia: No outbreaks reported. The MoH is working to prevent outbreaks of infectious diseases while putting in place control measures in case an outbreak of infectious diseases does occur. Disease surveillance has confirmed that all reported cases of acute respiratory infections (ARIs) were due to the common cold.
• Maldives: No outbreaks have been reported. The WHO field office and the Ministry of Health (MoH) are discussing changes to the current reporting system to make it more accurate and complete.
• Somalia: WHO is working with the MoH to collect surveillance data.
• Sri Lanka: No disease outbreaks have been reported. The disease surveillance system is in place. No further cases of measles have been reported after an entire camp in Galle district was vaccinated in response to one confirmed measles case reported ten days ago. Currently, there are 498 international health workers throughout Sri Lanka.
• Thailand: Disease surveillance is being carried out daily and so far no outbreaks have been identified.

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

Clean water and sanitation saves lives and protects health.

• India: Water samples in Tamil Nadu are being tested for residual chlorine by a MoH/WHO team as part of the WHO India Environmental Health support for the response.
• Malaysia: The Food Quality Control Division of the MoH continues the food safety quality assessments that were started on 1 January. In the states of Pulau Pinang and Kedah, operational relief centres were evaluated for food preparation and food samples and were found satisfactory.
• Maldives: Drinking water shortages continue in some islands.
• Sri Lanka: Water and sanitation experts confirm that while water is provided in sufficient quantity/quality in displacement camps in Galle, the sanitation infrastructure needs to be strengthened. The International Federation of the Red Cross and Red Crescent Societies (IFRC) is providing drinking water to more than 20,000 people. Red Cross branches in Hambantota, Ampara, Kalutara and Matara will clean 3100 wells within the next few weeks. The WHO Ampara team has informed the MoH Medical Supply Unit of a shortage of water-purification tablets in Ampara and Kalmunai districts.

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

The tsunami and earthquake affected vulnerable populations such as women, children, elderly, poor more than most

• India: A WHO assessment has indicated the need for a coordinated approach with standard materials for the many NGOs that are providing counseling in the affected areas. All agencies have agreed to this and a plan for training in Tamil Nadu is being developed. Psychiatric departments of medical schools and hospitals in other affected states are supporting NGOs active in the field.
• Indonesia: In villages in western Aceh the rapid health assessment team found a significant number of unaccompanied children needing additional assistance and support. The team has suggested that a measles vaccination campaign be extended to the region to cover all children under 15 years of age and to include the distribution of vitamin A capsules to those aged 6 to 59 months.

Health system and infrastructure (functioning health facilities, access)

Relief work must support the reconstruction of a sustainable health system.

• Indonesia: In Aceh, the focus will need to be on rebuilding damaged health infrastructure and finding health workers for villages that lack sufficient health care people. 50% of health staff in the district are either dead or missing. In Banda Aceh, the Zainoel Abidin Hospital used to be a 400-bed teaching hospital. Out of 911 employees, approximately 100 are confirmed dead. Equipment is covered by mud. All documents (such as patient information files) are destroyed.
• Malaysia: Medical treatment continues to be provided to disaster survivors at hospitals, health centres and at disaster relief centres. Initially, there were a total of 29 disaster relief centres opened in the affected states. Today five remain operational (4 in Kedah and 1 in Pulau Pinant) with a total of 3,213 individuals.
• Sri Lanka: All hospitals are functioning. WHO is collaborating with the World Bank to assess health facilities and provide guidance for the ongoing repair work. Red Cross and Red Crescent Society (IFRC) teams are providing health care services in affected areas in eastern Sri Lanka and have reported that basic health care training, education and psychosocial support is needed in affected areas.

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.

WHO Country Information

Indonesia: The inter-agency rapid health assessment team accompanied by officials from the UN, the Indonesian military, the MoH and the US Marine Corps conducted its third day of assessments along the west coast of Aceh. Four teams were again deployed by helicopter to four different areas. It is crucial to plan activities strategically in terms of both sector and location as the high turnover of agencies in some areas makes it difficult for local administrators to coordinate and prioritize the distribution of aid. Along with coordination, it is important to maintain a sustained commitment to the communities receiving assistance. More and more agencies and NGOs are using the 2-page quick assessment form prepared by the UN/OCHA Humanitarian Information Centre. WHO encourages this and urges organizations to pass the forms back to HIC in Banda Aceh as quickly as possible to assist information gathering, processing and sharing.

MAP: Indonesia - Aceh province

• View map
  gif, 118kb

India: A WHO expert has completed an assessment of psycho-social needs and recommends greater coordination and use of standard materials in order to move towards “normalization”.

Sri Lanka: A large consignment of medical supplies has arrived yesterday from Canada. It has already been received by WHO logistics, and will be provided to the ministry of health.

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 (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.